50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Pectointercostal Fascial Plane Block with or without Rectus Sheath Block in Cardiac Surgery:

A Double-Blind Prospective Randomized Controlled Trial

Anne L. Castro, MD1, HemanckurMakker, MD1, Laura Gonzalez, MD1, Audrey Jensen, MD2, Adam Pagryzinski, MD1, Rozalin Thapa, DO1, Christopher Fadumiye, MD1, Ali Qureshi, BS3,

Krystal Weierstahl, DO1, Ryan Traudt, MD1, Julie Freed, MD, PhD1

1 Medical College of Wisconsin Department of Anesthesiology 2 Mercy Health, Buffalo, NY 3Medical College of Wisconsin

Background

Median sternotomy, chest tube insertion, and internal chest tube sites primarily drive post-cardiac surgical pain1
Pectointercostal fascial plane blocks (PIFB) provide analgesic benefit for median sternotomy pain after cardiac surgery2
Rectus Sheath Block (RSB) targets anterior cutaneous branches of intercostal nerves that innervate sub-xiphoid chest tube insertion site3
Studies examining the combination of PIFB + RSB are limited, with conflicting findings4,5,6

Hypothesis

PIFB + RSB will provide more effective pain control than PIFB alone in patients undergoing cardiac surgery

Methods

Inclusion criteria: 18-85 year-olds undergoing CABG +/- single valve surgery with primary median sternotomy
Exclusion criteria designed to identify patients unlikely to be extubated within six hours, or chronic opioid use
Patients randomized to bilateral PIFB (15mL 0.25% bupi w/epi 1:200k) + RSB (10mL 0.25% bupi w/epi 1:200k OR placebo, 0.9% NS)
Primary Outcomes: Pain scores at rest and with deep breathing within the first 24h after anesthesia stop
Secondary Outcomes: Total cumulative opioid consumption at 24 and 48 hours postop

Change from baseline on incentive spirometry in first 24h
Time to extubation after surgery
Hospital and ICU length of stay
QoR-15 score7 24 hours after extubation

Results

167 patients screened  62 randomized  60 completed all study procedures (2 subjects removed post-randomization for surgical complications)
No differences in patient group characteristics or multimodal administration
- No differences in primary or secondary outcomes between groups

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

PECTOINTERCOSTAL FASCIAL PLANE BLOCK WITH OR WITHOUT RECTUS SHEATH BLOCK IN CARDIAC SURGERY: DOUBLE-BLIND PROSPECTIVE RCT

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