Efficacy of Ropivacaine Infiltration by Presternal Multi-orifice Catheter for Post-Sternotomy Pain Relief in Adult Patients Undergoing Cardiac Surgery—A Prospective, Randomized, Control Study

BACKGROUND AND AIMS: Post-sternotomy pain management remains a key concern in adult cardiac surgery. This study evaluated the efficacy and safety of ropivacaine infiltration via a presternal multi-orifice catheter for postoperative analgesia. DESIGN: A prospective randomized controlled trial. SETTING: A single tertiary care center. MATERIAL AND METHODS: A total of 175 adult patients undergoing cardiac surgery via median sternotomy were randomized into three groups: Group A (n = 58): Received 0.375% ropivacaine as continuous infusion at 5 mL/hour, Group B (n = 58): Received 5 mL of 0.375% ropivacaine as intermittent boluses every 8 hours, and Group C (n = 59): Received conventional intravenous tramadol. Pain was assessed using the visual analogue scale (VAS) for 48 hours post-extubation. Intravenous tramadol was used as rescue analgesia if VAS≥3. RESULTS: Group B reported significantly lower VAS scores and rescue tramadol requirements (56 ± 35 mg) compared to Group A (155 ± 32 mg) and Group C (135 ± 45 mg). No significant differences were observed among the groups regarding hemodynamic parameters, catheter-related infections, time to extubation, or intensive care unit (ICU) stay. CONCLUSION: Presternal infiltration of 0.375% ropivacaine is safe and effective for post-sternotomy analgesia. The intermittent bolus technique provides superior pain relief and reduces opioid consumption compared to continuous infusion and standard intravenous analgesia.