Analgesic efficacy of continuous superficial parasternal intercostal plane blockade in patients undergoing cardiac surgery with median sternotomy: a randomized controlled trial
Bibliographic record
Abstract
BACKGROUND: Single-injection superficial parasternal intercostal plane (SPIP) blockade provides an effective and low-risk analgesic option for patients undergoing cardiac surgery with sternotomy, but their duration is limited. We sought to evaluate whether continuous SPIP blockade, compared with single-injection SPIP blockade, reduces acute sternal pain on coughing at 24 hours after cardiac surgery. METHODS: We conducted a randomized controlled parallel-arm superiority trial at a tertiary care center in Vancouver, BC, Canada. We included English-speaking adult patients undergoing scheduled cardiac surgery with full median sternotomy. We randomized participants in a 1:1 ratio to intervention or control groups, stratified by sex, using permuted block randomization with variable block sizes of 4 or 6. Patients in both study groups received bilateral SPIP catheters, with a 20 mL bolus of ropivacaine 0.2% through each catheter followed by a 3 mL/hour infusion of study solution (ropivacaine 0.2% in the intervention group and normal saline in the control group) for 48 hours. All patients received standardized multimodal analgesia. The primary outcome was the numeric rating scale (NRS) sternal pain score on standardized coughing at 24 hours. Secondary outcomes included sternal pain within 48 hours, opioid use, quality of recovery, postoperative nausea or vomiting and chronic sternal pain. Patients, healthcare providers, outcome collectors and data analysts were blinded to group allocation. RESULTS: Eighty patients were randomized (n=40 per group). Mean (SD) sternal pain (NRS) scores on coughing at 24 hours were 4.0 (2.2) in the intervention group versus 3.9 (2.2) in the control group. The adjusted mean difference was -0.2 (95% CI -1.7 to 1.3; p=0.79). There were no differences between the groups in secondary outcomes. One patient in the intervention group experienced suspected local anesthetic systemic toxicity requiring unblinding. No other major complications were noted. CONCLUSIONS: Continuous SPIP blockade did not demonstrate superiority over single-injection SPIP blockade in reducing acute sternal pain on coughing at 24 hours after cardiac surgery. TRIAL REGISTRATION NUMBER: NCT05054179.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".