Abstract / Summary
Background: Ultrasound-guided facial plane blocks are central to enhanced recovery after cardiac surgery (ERACS) protocols, yet evidence comparing pecto-intercostal facial plane block (PIFB) and transversus thoracic facial plane block (TTPB) with rectus sheath block (RSB) remains limited.
Methods: This prospective, randomized, controlled trial enrolled 100 adult patients (ASA II-III) undergoing elective median sternotomy at a tertiary care hospital in South India. Patients received standardized general anesthesia and were randomized to bilateral PIFB or TTPB (20 mL 0.25% bupivacaine + 4 mg dexamethasone per side) with RSB after cardiopulmonary bypass. The primary outcome was 24-hour postoperative fentanyl consumption. Secondary outcomes included visual analog scale (VAS) pain scores at 0, 3-, 6-, 12-, and 24-hours post-extubation, rescue analgesia, extubation timing, ICU/hospital stay, and complications.
Results: A total of 96 patients completed analysis (PIFB: n = 47; TTPB: n = 49). Mean 24-hour fentanyl consumption was 267.23 ± 92.54 µg (PIFB) vs 297.18 ± 88.09 µg (TTPB), mean difference - 29.95 µg (95% confidence interval: -66.60 to 6.70; P = 0.108). VAS scores showed no significant between-group differences (P > 0.05). Rescue analgesia rates were similar, with 84% and 90% not requiring additional opioids. Four PIFB patients (8%) stayed intubated >24 hours due to cardiac issues, vs none in the TTPB group (P = 0.121).
Conclusion: This trial found no significant difference in opioid consumption or pain scores between PIFB + RSB and TTPB + RSB for post-sternotomy analgesia. Both techniques were safe within ERACS protocols. Larger noninferiority trials are needed before establishing equivalence or recommending one technique over another.