Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial

Khera, Tanvi; Murugappan, Kadhiresan R.; Leibowitz, Akiva; Bareli, Noa; Shankar, Puja; Gilleland, Scott; Wilson, K.; Oren-Grinberg, Achikam; Novack, Victor; Senthilnathan, Venkatachalam; Rangasamy, Valluvan; Subramaniam, Balachundhar

doi:10.1053/j.jvca.2020.07.058

Cited by 63 publications

(40 citation statements)

References 21 publications

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“…Although minithoracotomy techniques have been developed recently against such concerns, median sternotomy is still the gold standard incision in cardiovascular surgeries. In order to reduce the postoperative pain of this type of incision, new pain management techniques including TEA, PVB, Parasternal block and pecto-intercostal fascial block have been developed in recent years (3,4,10,11). Since the sternum is innervated by T2-T6 intercostal nerves, none of these techniques alone can be expected to produce adequate analgesia for median sternotomy.…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial

Güven

ERTÜRK

Ersoy

2022

Journal of Health Sciences and Medicine

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Introduction: There are few randomized controlled trials examining the effectiveness of bilateral Erector Spinae Plane Block (ESP) with patients undergoing cardiac surgery. The effect of bilateral ESP block on postoperative pain levels and analgesic consumption for patients undergoing open-heart surgery was examined in this single-blind, randomized, controlled trial.Material and Method: 54 patients who underwent cardiac surgery with open median sternotomy under general anesthesia between May 2020 and June 2021 were included in the study. Patients were randomized into two groups, each consisting of 27 patients, one with 40 ml of 0.25% bupivacaine and bilateral ESP block, the other with no block implementation (control group). Demographic data, operation type, length of stay in the Intensive Care Unit (ICU), numerical rating scale (NRS) values in the first 24 hours after extubation, and morphine consumption values of the patients were recorded for the study.Results: In the study, 4 patients were excluded from follow-up due to prolonged intubation in the postoperative period. The data of a total of 50 patients (ESP group n=25; Control group n=25) were analyzed. The duration before first analgesic (mean±SD: 459.2±92.8 min.) of the ESP group was statistically longer than those in the control group (mean±SD: 142.0±56.6 min.) (p<0.001). The total length of stay in the ICU and rate of nausea-vomiting were lower for the ESP group than for the control group (p<0.05). Total morphine consumption (mean±SD: 5.1±3.1 mg) of the ESP group in the first 24 hours was statistically lower (p<0.001) compared to the consumption of the control group (mean±SD: 14.8±4.2 mg). NRS scores were significantly lower for the ESP group at postoperative 1st, 2nd, 4th, 6th, and 8th hours compared to the control group (p<0.05). Conclusion:ESP block applied bilaterally in adult cardiac surgeries decreased postoperative pain scores and morphine consumption. At the same time, it was observed that the length of stay of the patients in the ICU was reduced and there were no complications.

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Section: Discussionmentioning

confidence: 99%

Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial

Güven

ERTÜRK

Ersoy

2022

Journal of Health Sciences and Medicine

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“…The pecto-intercostal fascial plane block has similarly been described as a postextubation rescue strategy for intractable acute poststernotomy pain [51]. A small RCT of surgicallyadministered parasternal-intercostal blocks in 30 paediatric patients demonstrated shorter times to extubation in conjunction with reduced pain scores [52]. However, a more recent RCT of pecto-intercostal fascial plane blocks in adult cardiac surgical patients did not demonstrate meaningful benefit vs. placebo, indicating the need for further investigation into its role in enhanced recovery pathways [53].…”

Section: Anteromedial Chest Wallmentioning

confidence: 99%

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

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“…The more superficial location potentially decreases the risk of pneumothorax while still providing post-sternotomy pain control. Similar to TTMP blocks, patients who received PIFB had decreased pain scores but the amount of opioid consumption was not significant decreased compared to placebo control [13]. There has not yet been a study published comparing TTMP to PIFB for post-sternotomy pain control and risk of complications.…”

mentioning

confidence: 92%

“…Another popular technique that has been recently described that also targets the anterior intercostal nerves is the pecto-intercostal fascial block (PIFB) also called parasternal intercostal nerve block (PINB)[3]. For PIFB, local anesthetic is deposited between the pectoralis major and intercostal muscles making the location more superficial to TTMP block [13]. The more superficial location potentially decreases the risk of pneumothorax while still providing post-sternotomy pain control.…”

mentioning

confidence: 99%

Regional analgesia in Cardiac anesthesia: Welcoming a new era in perioperative pain management.

Aljure

2021

Preprint

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Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial

Cited by 63 publications

References 21 publications

Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial

Postoperative analgesic effectiveness of bilateral erector spinae plane block for adult cardiac surgery: a randomized controlled trial

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Regional analgesia in Cardiac anesthesia: Welcoming a new era in perioperative pain management.

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