{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T02:22:35Z","timestamp":1782440555356,"version":"3.54.5"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2024,10,15]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While superficial parasternal intercostal plane blocks can improve analgesia after cardiac surgery, the optimal site and the number of injections remain uncertain. This study aimed to compare the efficacy of single versus double injections of superficial parasternal blocks, hypothesizing that double injections would achieve superior cutaneous sensory blockade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>70 cardiac patients undergoing median sternotomy were randomly assigned to receive either single or double injections of superficial parasternal blocks bilaterally. Each patient received 40\u2009mL of 0.25% bupivacaine with epinephrine 5\u2009\u00b5g\/mL and dexamethasone 10\u2009mg. The single-injection group received 20\u2009mL\/side at the third costal cartilage, while the double-injection group received 10\u2009mL\/injection at the second and fourth costal cartilages. The primary outcome was a successful block, defined as sensory loss in the T2\u2013T6 dermatomes. Secondary outcomes included sensory block of T1, T7, and T8 dermatomes, block-related complications, intraoperative hemodynamics, postoperative pain intensity, opioid consumption, and recovery quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Double injections achieved an overall higher success rate compared with the single-injection technique (81% vs 51%, relative risk 1.6; 95%\u2009CI 1.2, 2.0; p&lt;0.001). Additionally, higher blockade percentages were observed in dermatomes T1 (83% vs 59%, p=0.003), T7 (67% vs 46%, p=0.017), and T8 (61% vs 39%, p=0.011) with double injections. Other secondary outcomes did not differ significantly between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with single injection, double injections of superficial parasternal blocks provided more reliable coverage of the T2\u2013T6 dermatomes, crucial for median sternotomy. However, no differences were observed in intraoperative hemodynamic effects or postoperative pain control after cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>TCTR20230408004.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2024-105736","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T18:45:20Z","timestamp":1730832320000},"page":"174-180","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Successful cutaneous sensory blockade following single-injection and double-injection techniques of ultrasound-guided superficial parasternal intercostal plane block: a randomized clinical trial"],"prefix":"10.1136","volume":"51","author":[{"given":"Artid","family":"Samerchua","sequence":"first","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chalita","family":"Sroiwong","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1758-1297","authenticated-orcid":false,"given":"Panuwat","family":"Lapisatepun","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3934-9002","authenticated-orcid":false,"given":"Prangmalee","family":"Leurcharusmee","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanyong","family":"Pipanmekaporn","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wariya","family":"Sukhupragarn","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Settapong","family":"Boonsri","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nutchanart","family":"Bunchungmongkol","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kittitorn","family":"Pansuan","sequence":"additional","affiliation":[{"name":"Anesthesiology, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarit","family":"Phothikun","sequence":"additional","affiliation":[{"name":"Surgery, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"2026020508450688000_51.2.174.1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1053\/j.jvca.2023.01.012","article-title":"Pro: Regional Anesthesia for Cardiac Surgery With Sternotomy","volume":"37","author":"Rubio","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026020508450688000_51.2.174.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinane.2021.110577","article-title":"Persistent and acute postoperative pain after cardiac surgery with anterolateral thoracotomy or median sternotomy: A prospective observational study","volume":"77","author":"Korsik","year":"2022","journal-title":"J Clin Anesth"},{"key":"2026020508450688000_51.2.174.3","doi-asserted-by":"crossref","unstructured":"DiMarco RF . 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