Efficacy of Combined Pecto-Intercostal and Recto-Intercostal Fascial Plane Blocks for Cardiac Surgery: A Prospective, Randomized, Controlled Trial
Burak Ömür1, Yahya Yıldız1, Erkan Cem Çelik2, Selçuk Alver3, Ibrahim Hakkı Tor4, Bahadır Çiftçi11Department of Anesthesiology and Reanimation, İstanbul Medipol University, İstanbul, Türkiye2Department of Anesthesiology and Reanimation, Ataturk University Faculty of Medicine, Erzurum, Türkiye
3Department of Anesthesiology and Reanimation, Biruni University, İstanbul, Türkiye
4Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
Objectives: The aim of this study was to evaluate the effects of combined bilateral pecto-intercostal fascial plane block (PIFB) and recto-intercostal fascial plane block (RIFPB) on the quality of postoperative analgesia and recovery in cardiac surgery patients undergoing median sternotomy.
Methods: This prospective, randomized controlled study was conducted in 40 patients who underwent cardiac surgery via median sternotomy. Patients were randomized into two groups: the block group (PIFB+RIFPB, n=20) and the control group (no regional block, n=20). The primary outcome measure was postoperative pain scores (NRS) during the first 24 hours. Secondary outcomes were the Quality of Recovery-15 (QoR-15) score at 24 hours postoperatively, opioid consumption, and opioid-related side effects. Blocks were performed bilaterally using PIFB (20 mL of 0.25% bupivacaine on each side) and RIFPB (10 mL of 0.25% bupivacaine on each side) under ultrasound guidance.
Results: Pain scores (NRS) were significantly lower in the block group during the first 24 postoperative hours, both at rest and during movement. Consequently, QoR-15 scores at 24 hours were significantly higher in the block group than in the control group. Tramadol consumption was significantly lower in the block group. Additionally, opioid-related side effects, such as nausea and vomiting, were significantly less common in the block group. No complications related to the blocks were observed.
Conclusion: The combination of bilateral PIFB and RIFPB after median sternotomy significantly improved postoperative analgesia, reduced opioid use, and increased the quality of recovery by minimizing side effects. These results, evaluated for the first time in a prospective random-ized controlled trial, indicate that the combination of PIFB and RIFPB can be included in multimodal analgesia protocols in cardiac surgery.
Keywords: Cardiac surgery, epigastric drain, median sternotomy, pecto-intercostal fascial plane block, postoperative analgesia, recto-intercostal fascial plane block
Manuscript Language: English