A New Perspective in Cardiac Surgery: Single- and Two-level Deep Parasternal Intercostal Plane Blocks for Median Sternotomy Pain

Objectives: To compare the efficacy of single-level and two-level deep parasternal intercostal plane (DPIP) blocks in managing postoperative pain in cardiac surgery patients undergoing median sternotomy. Design: A prospective, randomized controlled study. Setting: A cardiac surgery unit in a tertiary hospital, conducted under institutional ethical approval. Participants: Adult patients (≥18 years) undergoing elective coronary artery bypass grafting (CABG), valve surgery, or combined CABG + valve procedures. Exclusion criteria included allergies to local anesthetics, emergency surgeries, reoperations, chronic pain, and major comorbidities. Interventions: Single-level DPIP block: 10 mL of 0.25% bupivacaine bilaterally at the T4/5 intercostal space. Two-level DPIP block: 5 mL bilaterally at T2/3 and T5/6 intercostal spaces. All blocks were administered preoperatively under ultrasound guidance. Measurements and Main Results: Both techniques provided effective analgesia. However, single-level blocks yielded significantly lower pain scores at 4, 6, and 8 hours, particularly during movement and in patients undergoing CABG. Differences decreased at 12 hours and disappeared by 24 hours. Pain scores were inversely correlated with age. No block-related complications were observed. Conclusions: Single-level DPIP blocks demonstrated more consistent early analgesia and were technically simpler to perform. Given their efficacy, safety, and efficiency, single-level blocks may serve as a practical alternative for routine use in cardiac surgery. Further research is warranted to optimize block level, volume, and concentration based on patient and surgical characteristics.