Maximum Extension and Regression Rate of Cutaneous Sensory Block: Superficial vs. Deep Parasternal Intercostal Plane Blocks in Patients Undergoing Open Cardiac Surgery

Abstract

Background: Superficial and deep parasternal intercostal plane (S-PIP and D-PIP, respectively) blocks provide effective analgesia following median sternotomy; however, data regarding their sensory distribution and regression patterns are scarce. Therefore, we compared the extent of sensory blockade 30 min following the administration of the blocks and evaluated its regression over 24 h. Methods: Patients who underwent open cardiac surgery under the S-PIP or D-PIP block were included in this single-center, prospective study. Sensory assessment using cold stimulation and dermatomal mapping was conducted 30 min, 12 h, and 24 h following the administration of the blocks. The primary outcome was the proportion of the blocked thoracic area at 30 min. Opioid consumption and pain scores at 12 and 24 h were the secondary outcomes. Results: Thirty patients were included in this study (n = 15 per group). The total blocked area at 30 min in the S-PIP and D-PIP groups was similar (48.48 +/- 9.50 % vs. 46.51 +/- 10.01 %, p = 0.584). Both blocks provided consistent coverage of the T2-T6 nerves, with additional involvement of T1 and T7 in some patients. Significant sensory blockade persisted at 12 h and partially regressed after 24 h. No significant differences were observed between the groups in terms of postoperative opioid consumption (10 [5] mg vs. 9 [3] mg, p = 0.121) or pain scores. Conclusion: The S-PIP and D-PIP blocks provided comparable and extensive sensory coverage of the anterior thorax. Consistent dermatomal involvement between T2 and T6 was observed, with occasional spread to T1 and T7.