Efficacy of Surgeon-Administered Regional Anesthesia in Cardiac Surgery: A Double-Blinded, 2-Center, Randomized, Placebo-Controlled Trial

Jonas Juel Rasmussen; Jannie Bisgaard; Jesper Langhoff Hønge; Phillip Kaasgaard Sperling; Carsten Simonsen; Peter Juhl-Olsen; Ivy Susanne Modrau

doi:10.1053/j.jvca.2026.03.042

Efficacy of Surgeon-Administered Regional Anesthesia in Cardiac Surgery: A Double-Blinded, 2-Center, Randomized, Placebo-Controlled Trial

J Cardiothorac Vasc Anesth. 2026 Mar 27:S1053-0770(26)00271-5. doi: 10.1053/j.jvca.2026.03.042. Online ahead of print.

Authors

Jonas Juel Rasmussen¹, Jannie Bisgaard², Jesper Langhoff Hønge³, Phillip Kaasgaard Sperling⁴, Carsten Simonsen⁵, Peter Juhl-Olsen⁶, Ivy Susanne Modrau⁶

Affiliations

¹ Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address: jonrau@rm.dk.
² Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³ Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark.
⁵ Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.
⁶ Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

PMID: 42034532
DOI: 10.1053/j.jvca.2026.03.042

Abstract

Objectives: Managing pain after median sternotomy is a clinical challenge of balancing adequate pain relief with avoidance of excessive opioid consumption. While regional anesthesia techniques are increasingly recommended and applied in cardiac surgery, evidence of sustained postoperative benefit remains limited and heterogeneous. The authors aimed to evaluate the efficacy and safety of long-acting regional infiltration anesthesia in patients undergoing coronary artery bypass grafting.

Design: The trial was conducted as a double-blinded, placebo-controlled trial in which participants were randomized 1:1 to intervention or placebo.

Setting: Cardiothoracic departments at 2 Danish university hospitals.

Participants: Patients undergoing non-emergent coronary artery bypass grafting.

Interventions: Participants were allocated to receive surgeon-administered intraoperative infiltration of the sternum and chest wall with either 62.5 mL of bupivacaine with epinephrine, clonidine, and dexamethasone or an equivalent volume of isotonic saline solution as placebo.

Measurements and main results: The primary endpoint was total opioid consumption within the first 24 postoperative hours. Secondary endpoints included patient-reported postoperative pain, as well as measures of recovery, respiratory impact, and chronic opioid use. A total of 113 patients were randomized, with 100 patients completing the trial and being included in the final analysis. No difference in opioid consumption was observed between the two groups. The median oral morphine equivalents were 62.3 mg (interquartile range, 70.8 mg) in the active intervention group and 64.0 mg (interquartile range, 46.8 mg) in the placebo group (p = 0.649). None of the secondary or safety endpoints showed significant differences.

Conclusions: In this double-blind, randomized trial, surgeon-administered regional anesthesia did not reduce opioid consumption or provide additional clinical benefits following median sternotomy.

Keywords: Enhanced Recovery After Surgery; cardiac surgery; opioid-sparing strategies; postoperative pain; regional anesthesia.