Continuous Ropivacaine Infusion Offers No Benefit in Treating Postoperative Pain After Cardiac Surgery

Objective: One multimodal pain management method for reducing postoperative opioid need after cardiac surgery is to continuously infuse local anesthetic into a median sternotomy wound. Previous studies have shown contradictory results with this method; therefore, no consensus exists on its effectiveness. The authors tested the effectiveness of continuous 0.2% ropivacaine infusion into a sternotomy wound after cardiac surgery.

Design: Prospective, randomized, double-blinded, placebo-controlled trial.

Setting: Single-institution, tertiary-level, university hospital.

Participants: Total of 90 patients undergoing coronary artery bypass grafting or heart valve surgery.

Interventions: Patients were assigned randomly to receive 0.2% ropivacaine or placebo into a sternotomy wound for 48 hours postoperatively. Pain was controlled with standardized oxycodone boluses after surgery and patient-controlled analgesia oxycodone after extubation; total oxycodone consumption was recorded. Pain was assessed 3 times daily, at rest and during deep breathing, with the visual analogue scale.

Measurements and main results: Forty-seven patients were assigned to receive ropivacaine and 43 to receive placebo infusion. Cumulative oxycodone consumption was 97 ± 27 mg with ropivacaine and 96 ± 29 mg with placebo (p = 0.813). Pain scores were similar between groups, both at rest (p = 0.630) and during deep breathing (p = 0.793). Adverse event incidences and surgical wound infection rates were similar between groups.

Conclusion: Continuous 0.2% ropivacaine infusions at the median sternotomy wound did not reduce postoperative pain or opioid consumption during the first 48 hours after cardiac surgery. This technique apparently was not beneficial for post-sternotomy pain treatment.