Introduction Effective treatment of
postoperative pain due to
median sternotomy speeds up hemodynamic healing of patients. For this purpose,
opioids with a wide range of side effects are widely used at high doses. The aim of this study is to investigate the effect of continuous
local anesthetic (
bupivacaine) infusion on
opioid use on cardiac surgery patients undergoing
median sternotomy. Methods A total of 215 patients undergoing isolated
coronary artery bypass grafting surgery were included in the study; and 105 patients who underwent parasternal continuous
local anesthetic infusion (0.5%
bupivacaine at 4 mL/h, for 48h) were determined as
local anesthesia group and other patients were as control group. The primary outcomes evaluated between the groups in the postoperative period were
pain scores (VAS: Visual Analogic Score, PHHPS: Prince Henry Hospital
Pain Score) and the number of
opioids used. Secondary outcomes were
mechanical ventilation time, intensive care unit and
hospital stay duration, development of
atrial fibrillation and
atelectasis. Results
Postoperative pain was found to be significantly lower in the
local anesthesia group compared to the control group (VAS: 3 ± 1.9 vs 6.4 ± 1.8, p < 0.001; PHHPS: 0.9 ± 0.8 vs 1.62 ± 0.82, p < 0.001). As a result of this,
opioid drug use was significantly lower in the
local anesthesia group compared to the control group (0 (0 - 4) vs 1 (0 - 8), p < 0.001).
Mechanical ventilation time, intensive care unit and
hospital stay duration, and development of
atelectasis were significantly lower in the
local anesthesia group. In terms of the development of
atrial fibrillation, no significant difference was found between the groups. Conclusion Parasternal continuous
local anesthetic infusion reduces postoperative
opioid use and speeds up hemodynamic healing by preventing possible side effects of
opioids. It is a simple and effective method in the treatment of
postoperative pain due to
median sternotomy.