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Erschienen in: Intensive Care Medicine 1/2019

07.01.2019 | Original

The effect of local anesthetic continuous wound infusion for the prevention of postoperative pneumonia after on-pump cardiac surgery with sternotomy: the STERNOCAT randomized clinical trial

verfasst von: Julien Amour, Bernard Cholley, Alexandre Ouattara, Dan Longrois, Pascal Leprince, Jean-Luc Fellahi, Bruno Riou, Sarah Hariri, Christian Latrémouille, Alain Rémy, Sophie Provenchère, Aude Carillion, Paul Achouh, Louis Labrousse, Alexy Tran Dinh, Nora Ait Hamou, Ahmed Charfeddine, Alexandre Lafourcade, David Hajage, Adrien Bouglé, for the STERNOCAT investigators

Erschienen in: Intensive Care Medicine | Ausgabe 1/2019

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Abstract

Purpose

Postoperative pain after cardiac surgery, exacerbated by cough and sternal mobilization, limits clearance of bronchopulmonary secretions and may predispose to postoperative pneumonia. In this study, we tested the ability of local anesthetic continuous wound infusion to prevent pneumonia after cardiac surgery with sternotomy and cardiopulmonary bypass (CPB) owing to better analgesia and bronchopulmonary drainage.

Methods

In this randomized, double-blind, placebo-controlled trial conducted in five academic centers, patients undergoing cardiac surgery with sternotomy and CPB were enrolled from February 2012 until November 2014, and were followed over 30 days. Patients were assigned to a 48-h infusion (10 ml h−1) of l-bupivacaine (12.5 mg h−1) or placebo (saline) via a pre-sternal multiperforated catheter. Anesthesia and analgesia protocols were standardized. The primary end point was the incidence of pneumonia during the study period, i.e., until hospital discharge or 30 days. We hypothesized a 30% reduction in the incidence of pneumonia.

Results

Among 1493 randomized patients, 1439 completed the trial. Pneumonia occurred in 36/746 patients (4.9%) in the l-bupivacaine group and in 42/739 patients (5.7%) in the placebo group (absolute risk difference taking into account center and baseline risk of postoperative pneumonia, − 1.3% [95% CI − 3.4; 0.8] P = 0.22). In the predefined subgroup of patients at high risk, l-bupivacaine decreased the incidence of pneumonia (absolute risk difference, − 5.6% [95% CI − 10.0; − 1.1], P = 0.01).

Conclusions

After cardiac surgery with sternotomy, continuous wound infusion of l-bupivacaine failed to decrease the incidence of pneumonia. These findings do not support the use of local anesthetic continuous wound infusion in this indication. Further study should investigate its effect in high-risk patients.

Trial registration

EudraCT Number: 2011-003292-10; Clinicaltrials.gov Identifier: NCT01648777.
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Metadaten
Titel
The effect of local anesthetic continuous wound infusion for the prevention of postoperative pneumonia after on-pump cardiac surgery with sternotomy: the STERNOCAT randomized clinical trial
verfasst von
Julien Amour
Bernard Cholley
Alexandre Ouattara
Dan Longrois
Pascal Leprince
Jean-Luc Fellahi
Bruno Riou
Sarah Hariri
Christian Latrémouille
Alain Rémy
Sophie Provenchère
Aude Carillion
Paul Achouh
Louis Labrousse
Alexy Tran Dinh
Nora Ait Hamou
Ahmed Charfeddine
Alexandre Lafourcade
David Hajage
Adrien Bouglé
for the STERNOCAT investigators
Publikationsdatum
07.01.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 1/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5497-x

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