A prospective, randomized, blinded study of continuous ropivacaine infusion in the median sternotomy incision following cardiac surgery

Shvetank Agarwal, Gregory A. Nuttall, Michael E. Johnson, Andrew C. Hanson, William C. Oliver

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: The aim of this prospective, randomized, double-blind, placebo controlled trial was to evaluate the safety and efficacy of continuous ropivacaine infusion of into the sternal wound. Methods: We planned to enroll 200 patients scheduled for various cardiac surgical procedures into the study. Patients, in a double-blind randomized fashion, were given either normal saline or 0.3% ropivacaine through 2 subcutaneous multiport catheters placed on either side of the sternal split at an infusion rate of 4 mL/h for 64 hours. The efficacy outcomes measured were time to extubation of the trachea, intensive care unit and hospital stay duration, pain scores, and narcotic usage. The safety outcomes measured were systemic local anesthetic toxicity, major cardiac complications, and wound infection. MEASUREMENTS AND MAIN Results: The data safety monitoring board stopped the study after enrolling 85 patients because of excessive sternal wound infections (9%, n = 44) in the ropivacaine group. This rate of infection was not statistically different from the control group (0%, n = 41, P = 0.12), but it was statistically different from our historical incidence of sternal wound infection (1.9%, no = 6381, P = 0.002). There was also a lack of evidence of efficacy for time to extubation of the trachea, narcotic usage, and pain control. Conclusions: The phase III trial did not show improvement in time to extubation of the trachea or pain control in the 0.3% ropivacaine group, but it was stopped early by the data safety monitoring board.

Original languageEnglish (US)
Pages (from-to)145-150
Number of pages6
JournalRegional Anesthesia and Pain Medicine
Volume38
Issue number2
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

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Sternotomy
Thoracic Surgery
Wound Infection
Clinical Trials Data Monitoring Committees
Trachea
Narcotics
Pain
Cardiac Surgical Procedures
Safety
Local Anesthetics
Intensive Care Units
Length of Stay
Catheters
Placebos
Control Groups
ropivacaine
Incidence
Wounds and Injuries
Infection

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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A prospective, randomized, blinded study of continuous ropivacaine infusion in the median sternotomy incision following cardiac surgery. / Agarwal, Shvetank; Nuttall, Gregory A.; Johnson, Michael E.; Hanson, Andrew C.; Oliver, William C.

In: Regional Anesthesia and Pain Medicine, Vol. 38, No. 2, 01.03.2013, p. 145-150.

Research output: Contribution to journalArticle

Agarwal, Shvetank ; Nuttall, Gregory A. ; Johnson, Michael E. ; Hanson, Andrew C. ; Oliver, William C. / A prospective, randomized, blinded study of continuous ropivacaine infusion in the median sternotomy incision following cardiac surgery. In: Regional Anesthesia and Pain Medicine. 2013 ; Vol. 38, No. 2. pp. 145-150.
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