Superficial intercostal plane blocks for post-sternotomy pain control rationale and design for the EPOCH CardioLink-10 randomized clinical trial

Nitish K. Dhingra, Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network.
Fallon Dennis, Division Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Syed Mohammad Hassan, Department of Surgery, University of Toronto.
Adrian Quan, Division Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Hwee Teoh, Division Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Kyle Chin, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Michael J. Ricci, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
John D. Tran, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Jason Li, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Raj Verma, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Fábio de Vasconcelos Papa, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Youngseo Lee, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Ashton P. Chang, Department of Anesthesiology and Pain Medicine.
Jesus Igualada, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Juan F. Morales, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Juan P. Ghiringhelli, Department of Anesthesiology and Pain Medicine.
Kendra L. Derry, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Thomas George, Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto.
Amine Mazine, Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, VIC, Australia.
Ori D. Rotstein, Department of Surgery, University of Toronto.
Corey Adams, Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB.
Richard C. Cook, Division of Cardiac Surgery, Vancouver General Hospital.
Ansar Hassan, MaineHealth Maine Medical Center, Portland, Maine, USA.
Atul David Nagpal, Division of Cardiac Surgery.
Terrence M. Yau, Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network.
Jessica D. Spence, Departments of Anesthesia, Critical Care and Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, ON.
Korey Sutherland, Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, New Westminster, BC.
Pawel M. Martinka, Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, New Westminster, BC.
Christopher D. Noss, Department of Anesthesiology, Perioperative and Pain Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, AB.
James L. Dougherty, Department of Anesthesia, Pain Management & Peri-operative Medicine, Dalhousie University, Halifax, NS, Canada.
Pieter de Jager, Department of Anesthesia, Pain Management & Peri-operative Medicine, Dalhousie University, Halifax, NS, Canada.
Alexander J. Gregory, Department of Anesthesiology, Perioperative and Pain Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, AB.

Abstract

PURPOSE OF THE TRIAL: Inadequate pain control following cardiac surgery remains a significant clinical and socioeconomic burden. Superficial parasternal intercostal plane (SPIP) blocks are not widely utilized for reducing pain and opioid consumption post-cardiac surgery because the available evidence is weak and inconsistent. METHODS: The double-blind, placebo-controlled, multicenter EPOCH CardioLink-10 trial was designed to evaluate how continuous bilateral SPIP blocks affect opioid consumption and recovery-related endpoints among individuals who have undergone cardiac surgery via median sternotomy. Participants from four Canadian sites are randomized to receive either 0.2% ropivacaine or placebo (0.9% sodium chloride) for 48-h following bilateral catheter insertion into the SPIP. The primary outcome is cumulative postoperative opioid use (morphine milligram equivalents) up to 72-hours post-catheter insertion. Secondary endpoints include median pain scores and the incidence of delirium over the 72-hours post-catheter insertion; cumulative postoperative opioid use up to hospital discharge; and participant-reported quality of recovery 24-96 h post-surgery. SUMMARY: EPOCH CardioLink-10 is to date the largest randomized controlled trial to evaluate an Enhanced Recovery After Surgery (ERAS) intervention among individuals who are recuperating from cardiac surgery with median sternotomy. Its overarching goal is to obtain robust data to improve clinical care and inform on post-cardiac surgery pain management guidelines.