Deep parasternal intercostal plane block and its effects on left internal thoracic artery hemodynamics in coronary artery bypass grafting

Sep 29, 2026

Background investigates whether deep parasternal intercostal plane block can influence left internal thoracic artery (LITA) vasospasm in patients undergoing coronary artery bypass grafting. A prospective study enrolled 29 elective CABG patients between March 2024 and August 2024, using ultrasound-guided bilateral deep parasternal intercostal plane block with bupivacaine after anesthesia induction. LITA flow metrics and hemodynamics were compared immediately before (T0) and 30 minutes after (T1).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

Background

Methods

Results

Conclusion

Keywords

Turkish Journal of Thoracic and Cardiovascular Surgery 2025;33(4):451-459 Orıgınal Artıcle / Özgün Makale Deep parasternal intercostal plane block and its effects on left internal thoracic artery hemodynamics in coronary artery bypass grafting Koroner arter baypas greftlemede derin parasternal interkostal plan bloku ve sol internal torasik arter hemodinamiği üzerindeki etkileri Serkan Mola1􀀬, Enis Burak Gül1􀀬, Alp Yıldırım2􀀬, Nigar Gürer3􀀬, Nevriye Salman3􀀬 Institution where the research was done: Ankara Bilkent City Hospital, Ankara, Türkiye Author Affiliations: 1Department of Cardiovascular Surgery, Ankara Bilkent City Hospital, Ankara , Türkiye 2Department of Cardiovascular Surgery, Atatürk Sanatoryum Education and Research Hospital, Ankara, Türkiye 3Department of Anaesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara, Türkiye ABSTRACT Background: This study aims to investigate the effects of deep parasternal intercostal plane block on left internal thoracic artery vasospasm in coronary artery bypass grafting patients. Methods: Between March 2024 and August 2024, a total of 29 patients (24 males, 5 females; mean age: 60.1±8.3 years; range, 56 to 66 years) who were scheduled for elective coronary artery bypass grafting were included in this prospective study. An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction. Left internal thoracic artery peak systolic velocity, end-diastolic velocity, and resistive index, along with heart rate and mean arterial pressure, were recorded immediately before the block (T0) and 30 min after (T1). Demographics, body mass index, and comorbidities of the patients were noted. Results: After deep parasternal intercostal plane block administration, the left internal thoracic artery resistivity index decreased significantly (p=0.041), and the left internal thoracic artery diameter increased significantly (p=0.004) . Although the peak systolic velocity increased and the end-diastolic velocity decreased following the block, these changes were not statistically significant (p=0.145 and p=0.135, respectively) . Conclusion: Our study findings suggest that deep parasternal intercostal plane block administration may prevent left internal thoracic artery vasospasm by increasing arterial conduit diameter and reducing the resistivity index. Based on these findings, we believe that this method can be safely applied under ultrasound guidance without complications. Keywords: Coronary artery bypass grafting, deep parasternal intercostal plane block, left internal thoracic artery flow. ÖZ Amaç: Bu çalışmada, koroner arter baypas greftleme yapılan hastalarda derin parasternal interkostal plan blokunun sol internal torasik arter vazospazmı üzerindeki etkileri araştırıldı . Çalışma planı: Bu prospektif çalışmaya Mart 2024 -Ağustos 2024 tarihleri arasında elektif koroner arter baypas greftleme planlanan toplam 29 hasta (24 erkek, 5 kadın; ort. yaş: 60.1±8.3 yıl; dağılım, 56-66 yıl) alındı . Anestezi indüksiyonunu takiben her iki sternal kenara ultrason eşliğinde 15 mL %0.25 bupivakain ile derin parasternal interkostal plan bloku uygulandı . Sol internal torasik arter pik sistolik hızı, diyastol sonu hızı ve direnç indeksi ile birlikte kalp hızı ve ortalama arter basıncı blok öncesi (T0) ve bloktan 30 dk. sonra (T1) kaydedildi. Hastaların demografik özellikleri, beden kitleindeksleri ve eşlik eden hastalıkları not edildi. Bulgular: Derin parasternal interkostal plan bloku sonrası sol internal torasik arter direnç indeksi anlamlı olarak azaldı(p=0.041) ve sol internal torasik arter çapı anlamlı olarakarttı (p=0.004) . Blok sonrası pik sistolik hızı artmış ve diyastol sonu hız azalmış olmakla birlikte, bu değişiklikleristatistiksel olarak anlamlı değildi (sırasıyla p=0.145 vep=0.135) . Sonuç: Çalışma bulgularımız derin parasternal interkostal plan blokunun arter çapı

FAQs

What was the study trying to determine about CABG patients?

The study aimed to investigate how deep parasternal intercostal plane block affects left internal thoracic artery vasospasm in coronary artery bypass grafting patients.

How was the deep parasternal intercostal plane block performed in the study?

An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction.

What changes were observed in LITA parameters after the block?

After the block, the LITA resistivity index decreased significantly and the LITA diameter increased significantly. Peak systolic velocity increased and end-diastolic velocity decreased, but those changes were not statistically significant.

Sep 29, 2026

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