Effects of bilateral Pecto-intercostal Fascial Block for perioperative pain management in patients undergoing open cardiac surgery: a prospective randomized study

Abstract

Background Open cardiac surgical patients may experience severe acute poststernotomy pain. The ultrasound-guided Pecto-intercostal Fascial Block (PIFB) can cover anterior branches of intercostal nerves from T2 to T6. The aim of this study was to investigate the effect of bilateral PIFB in patients undergoing open cardiac surgery. Methods A group of 108 patients were randomly allocated to either receive bilateral PIFB (PIFB group) or no nerve block (SALI group). The primary endpoint was postoperative pain. The secondary outcome measures included intraoperative and postoperative sufentanil and parecoxib consumption, time to extubation, time to first feces, length of stay in the ICU and the length of hospital stay. Insulin, glucose, insulin resistance and interleukin (IL)-6 at 1, 2, 3 days after surgery were mearsured. The homeostasis model assessment (HOMA-IR) was used to measure perioperative insulin resistance. Results The PIFB group reported significantly less sufentanil and parecoxib consumption than the SALI group. Compared to the PIFB group, the SALI group had higher Numerical Rating Scale (NRS) pain scores at 24 h after operation both at rest and during coughing. The time to extubation, length of stay in the ICU and length of hospital stay were significantly decreased in the PIFB group compared with the SALI group. The PIFB group had a lower insulin, glucose, IL-6, HOMA-IR level than the SALI group 3 days after surgery. Conclusion Bilateral PIFB provides effective analgesia and accelerates recovery in patients undergoing open cardiac surgery. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2000030609) on 08/03/2020.

Effects of ultrasound-guided regional anesthesia in cardiac surgery: A systematic review and network meta-analysis

“…When we evaluated the other outcomes, the PIF block seemed to be the only one to increase extubation time with a statistically significant result by increasing the time. This result is highly influenced by one study 16 that showed a high difference among the groups. Therefore, further evidence for this outcome is warranted.…”

“…Fifteen studies evaluating four different regional anesthesia techniques were finally included for quantitative and qualitative analysis. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The regional and local anesthesia techniques included the pecto-intercostal fascial (PIF), transversus thoracis muscle plane (TTMP), erector spinae plane (ESP), and pectoralis nerve (PECS) I blocks ( Fig. 2).…”

Comment on: “Pecto-intercostal Fascial Block for perioperative pain management in patients undergoing open cardiac surgery”

“…Dear Editor, I read the recently published article that has analyzed the effectiveness of Pecto-intercostal Fascial Block (PIFB) for patients undergoing open cardiac surgery [1] with keen interest. I greatly appreciate Zhang et al for publishing this study in which PIFB, a novel technique for providing pain relief in open cardiac surgical procedures was evaluated [1]. I wish to present my comments on this article as well as to add a few more points on this topic.…”

“…Zhang et al [1] have stated in the "Discussion" section that their study was the first double-blind, randomized, controlled trial on PIFB in open cardiac surgeries. However, to my knowledge, two studies were published on the evaluation of PIFB in open cardiac procedures within a short span in July 2020 [2,3].…”

“…This was a single-blind study in which the postoperative nurses who monitored the outcomes were unaware of whether the block was performed or not, while the anesthesiologists performed the PIFB without any placebo group before transferring the patients to ICU [3]. In contrast to these studies [2, 3], Zhang et al have administered the PIFB before the surgery [1].…”