The Analgesic Efficacy of Local Anesthetics for the Incisional Administration following Port Access Heart Surgery: Bupivacaine versus Ropivacaine


  • Maja Sostaric
  • Borut Gersak
  • Vesna Novak-Jankovic



Background: To avoid large dose opioids, the authors investigated an alternative method for postoperative pain relief after Port Access cardiac surgery.

Methods: Out of 104 patients who underwent Port Access heart surgery, 78 patients who were extubated in the operating room were enrolled in the retrospective study. The standardized fast track cardiac anesthesia was used for all patients, and the catheter was placed in the surgical wound at the end of the operation. Analgesia was started with a bolus of bupivacaine (B group) or ropivacaine (R group) through the catheter and followed by continuous infusion of local anesthetic. The variables recorded were visual analogue scale (VAS) at extubation and during the first 24 hours, additional requirements of local anesthetic (LA), and opioid analgetic. Possible complications that could be connected with the catheter in the wound or with the administration of LA were recorded as well.

Results: There was no statistical difference between the R and B groups in mean pain score at extubation and in the first 24 hours. The groups were also comparable concerning the need for bolus application of the LA and opioid analgetic. The microbiological analysis of 9 randomly chosen catheter tips from both groups was sterile.

Conclusion: Both local anesthetics, ropivacaine and bupivacaine, are equally effective for pain relief after Port Access cardiac surgery. The catheter in surgical incision and application of LA through it does not increase the risk for wound infection and does not interfere with wound healing.


Cheng DC. 1998. Fast-track cardiac surgery: economic implications in postoperative care. J Cardiothorac Vasc Anesth 12:72-9.nDeneuville M, Bisserier A, Regnard JF, Chevalier M, Levasseur P, Hervé P. 1993. Continous intercostal analgesia with 0.5% bupivacaine after thoracotomy: a randomized study. Ann Thorac Surg 55:381-5.nDowling R, Thielmeier K, Ghaly A, Barber D, Boice D, Dine A. 2003. Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial. J Thorac Cardiovasc Surg 126:1271-8.nFredman B, Shapiro A, Zohar E, et al. 2000. The analesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg 91:1436-40.nGersak B, Sostaric M, Kalisnik JM, Blumauer R. 2005. The preferable use of port access surgical technique for right and left atrial procedures. Heart Surg Forum 8:E354-63.nGust R, Pecher S, Gust A, Hoffmann V, Böhrer H, Martin E. 1999. Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Crit Care Med 27:2218-23.nHopf HW, Hunt TK, West JM, et al. 1997. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 132:997-1004.nHynninen MS, Cheng DC, Hossain I, et al. 2000. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anaesth 47:1182-7.nKehlet H, Wilmore DW. 2005. Fast-track surgery. Br J Surg 92:3-4.nKhoury GF, Chen AC, Garland DE, Stein C. 1992. Intraarticular morphine, bupivacaine, and morphine/bupivacaine for pain control after knee videoarthroscopy. Anesthesiology 77:263-6.nKlein SM, Grant SA, Greengrass RA, et al. 2000. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg 91:1473-8.nPage GG, Blakely WP, Ben-Eliyahu S. 2001. Evidence that postoperative pain is a mediator of the tumor-promoting effects of surgery in rats. Pain 90:191-9.nRasmussen S, Larsen AS, Thomsen ST, Kehlet H. 1998. Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and covalescence after arthroscopic meniscectomy. Pain 78:131-4.nRoberge CW, McEwen M. 1998. The effects of local anesthetics on post-operative pain. AORN J 68:1003-12.nRosenberg PH, Renkonen OV. 1985. Antimicrobial activity of bupivacaine and morphine. Anesthesiology 62:178-9.nScott NB, Turfrey DJ, Ray DA, et al. 2001. A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting. Anesth Analg 93:528-35.nVintar N, Rawal N, Veselko M. 2005. Intraarticular patient-controlled regional anesthesia after arthroscopically assisted anterior cruciate ligament reconstruction: ropivacaine/morphine/ketorolac versus ropivacaine/morphine. Anesth Analg 101:573-8.nWhite PF, Rawal S, Latham P, et al. 2003. Use of a continous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 99:918-23.nWilmore DW. 2002. From Cuthberston to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 236:643-8.n



How to Cite

Sostaric, M., Gersak, B., & Novak-Jankovic, V. (2010). The Analgesic Efficacy of Local Anesthetics for the Incisional Administration following Port Access Heart Surgery: Bupivacaine versus Ropivacaine. The Heart Surgery Forum, 13(2), E96-E100.