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A nerve block near the breastbone reduced post-op pain in cardiac surgery patients but didn't meaningfully improve overall recovery at the 24-hour mark. The randomized trial of 126 patients found the deep parasternal intercostal plane (DPIP) block did show some benefits — including less opioid use during surgery and better recovery scores by day 5. The results suggest the block's effectiveness may depend on the type of surgery performed.
A new randomized trial found that a nerve block alongside the breastbone — called the deep parasternal intercostal plane (DPIP) block — reduced pain at certain timepoints after open-heart surgery but didn't significantly improve patients' overall quality of recovery at 24 hours compared to standard care. The study, published in the Journal of Cardiothoracic and Vascular Anesthesia, enrolled 126 adults who underwent cardiac surgery via median sternotomy at a French center between 2022 and 2025.
Patients in the DPIP group did show better recovery scores by day 5 and needed less remifentanil (an opioid) during surgery. However, post-op morphine use was similar between groups. Notably, a subgroup analysis of patients who had an internal mammary artery harvested showed significantly better 24-hour recovery scores with the DPIP block — hinting that the block may work best when surgical trauma overlaps with the nerve territories it covers.
By the Numbers:
Why it matters: As cardiac surgery teams look for ways to reduce opioid use and improve recovery, regional nerve blocks are an appealing option — but this study suggests the DPIP block isn't a one-size-fits-all solution. Patient selection and surgical approach may be key to unlocking its full benefit.
