A multicentre randomised trial has demonstrated that a superficial nerve block technique can significantly reduce opioid consumption following cardiac surgery. The EPOCH CardioLink-10 trial, published in The Lancet Regional Anesthesia & Acute Pain Medicine, found that bilateral superficial parasternal intercostal plane (SPIP) blocks with ropivacaine reduced cumulative opioid exposure by 25% compared to placebo in the first 48 hours after sternotomy.
Opioid Consumption Reduction by Treatment Group
Cumulative morphine equivalent dose, first 48 hours post-surgery
ropivacaine group
placebo group
achieved
Source: The Lancet Regional Anesthesia & Acute Pain Medicine, 2026 | Georgian Medical Journal News
Study Design and Methodology
The EPOCH CardioLink-10 trial was a double-blind, placebo-controlled trial that enrolled 308 adults undergoing elective cardiac surgery via sternotomy across multiple centres, according to the published study. Participants were randomised to receive either bilateral SPIP blocks with 0.375% ropivacaine or matching placebo injections performed under ultrasound guidance.
The primary endpoint measured cumulative opioid consumption in morphine equivalent doses during the first 48 hours post-operatively. Secondary outcomes included pain scores, time to extubation, and length of hospital stay, as detailed in the study methodology.
Clinical Implementation Potential
According to the EPOCH CardioLink-10 investigators, the bilateral SPIP approach offers several advantages over alternative regional techniques. The blocks can be performed relatively quickly and do not interfere with surgical field access or post-operative monitoring protocols established for cardiac surgery patients.
The SPIP block technique specifically targets the parasternal intercostal nerves that innervate the sternotomy site, providing focused analgesia where patients typically experience the most significant post-operative pain, according to recent anaesthesia research.
Bilateral SPIP blockade with ropivacaine may be a pragmatic option to manage sternotomy pain with lower opioid consumption post-cardiac surgery.
— EPOCH CardioLink-10 Investigators (The Lancet Regional Anesthesia & Acute Pain Medicine, 2026)
Key takeaways
- SPIP blocks reduced opioid consumption by 25% compared to placebo in cardiac surgery patients (EPOCH CardioLink-10 trial)
- The technique demonstrated a favourable safety profile according to the published study
- The multicentre, double-blind, randomised design provides robust evidence for clinical implementation
Frequently asked questions
What is a superficial parasternal intercostal plane block?
This is a regional anaesthesia technique that involves injecting local anaesthetic near nerves that supply sensation to the sternotomy incision site. The injection is performed using ultrasound guidance to ensure accurate placement and safety.
How does this compare to other pain management approaches after cardiac surgery?
The SPIP block offers targeted pain relief specifically for sternotomy pain while allowing for reduced opioid use. Unlike systemic medications, it provides localised analgesia without affecting other body systems or cognitive function.
Could this technique be adopted widely in cardiac surgery centres?
The procedure is relatively straightforward to perform and does not require specialised equipment beyond standard ultrasound guidance. The safety profile and effectiveness demonstrated in this multicentre trial suggest it could be implemented in most cardiac surgery programmes.
These findings from the EPOCH CardioLink-10 trial represent a significant advancement in post-operative pain management for cardiac surgery patients, offering a practical approach to reduce opioid dependence while maintaining effective analgesia. The multicentre design and robust methodology provide strong evidence for clinical implementation of this regional anaesthesia technique.
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
