Cardiothoracic & vascular anesthesia
Nociception level index-directed superficial parasternal intercostal plane block vs erector spinae plane block in open-heart surgery: a propensity matched non-inferiority clinical trial
Main finding · Total intraoperative fentanyl consumptionResult — go to the resultMedian difference 0.1 mg 95% CI 0.05–0.15Authors' conclusion
This study could not demonstrate that SPIPB was inferior to ESPB for intraoperative fentanyl consumption.
Study context
- Population
- Adults undergoing elective open-heart surgeryafter propensity matching
- Participants
- 19 vs 33
- Comparison
- Superficial parasternal intercostal plane block (SPIPB) vs erector spinae plane block (ESPB)
- SPIPBn = 19
- ESPBn = 33reference
- Outcome
- Total intraoperative fentanyl consumption (non-inferiority margin δ 0.1 mg)
Methodological detailssingle-centre, propensity-score matched, Nociception Level (NOL) index-directed anaesthesia, Fentanyl dosed to NOL index ≤ 25; postoperative paracetamol 1 g 6-hourly and morphine for numeric rating scale (NRS) ≥ 4
- Single-centre
- Propensity-score matched
- NOL index-directed anaesthesia
- Fentanyl dosed to NOL index ≤ 25; postoperative paracetamol 1 g 6-hourly and morphine for NRS ≥ 4
Main finding
Total intraoperative fentanyl consumption
Median difference
0.1 mg
95% CI 0.05–0.15
P = 0.558
SPIPB vs ESPB
median difference 0.1 mg (95% CI 0.05–0.15); P = 0.558
As reported in the abstract
Secondary outcomes
Postoperative morphine use · 24 h
P < 0.001
Postoperative morphine use · 48 h
P = 0.001
| Outcome | SPIPB | ESPB | P value |
|---|---|---|---|
| Time-weighted average NRS at rest over 48 h post-extubation | 1 (range 0–1) | 1 (range 1–2) | P = 0.004 |
| Time-weighted average NRS with movement over 48 h post-extubation | 2 (range 1–2) | 3 (range 2–3) | P = 0.002 |
- Postoperative morphine use: values as printed; SPIPB stated to lead to higher morphine use
Morphine-free at 48 h and time to first morphine dose
- Four times fewer SPIPB patients morphine-free at 48 h (p < 0.001)
- Time to first morphine dose three times shorter with SPIPB (p = 0.001)
Intraoperative NOL index
- Significantly higher average NOL index with SPIPB (p = 0.003)
- Greater NOL index variability with SPIPB (p = 0.027)
Original publication
Nociception level index-directed superficial parasternal intercostal plane block vs erector spinae plane block in open-heart surgery: a propensity matched non-inferiority clinical trial. J Clin Monit Comput. Published 29 October 2024. doi:10.
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