Abstract
BACKGROUND AND AIMS: No studies have assessed the pre-emptive analgesic efficacy of pecto-intercostal fascial plane block (PIFB). We evaluated the pre-emptive analgesic efficacy of PIFB by comparing with the routine in-hospital analgesic protocol for sternotomy pain in patients undergoing cardiac surgery. MATERIAL AND METHODS: This prospective, randomized, double-blinded study was conducted on 90 patients undergoing elective coronary artery bypass grafting surgery. The patients were randomized into two groups as follows: 1. PIFB group (n = 45): received bilateral ultrasound-guided bilateral PIFB with 0.5% levobupivacaine and 2. no PIFB (NPIFB) group (n = 45): received routine in-hospital perioperative analgesic protocol. The primary outcome of the study was to assess the effectiveness of PIFB on the requirement of intraoperative and postoperative fentanyl. The secondary outcomes were to assess the postoperative pain score, sedation alertness, side effects, and cooperation with incentive spirometry exercises. The Chi-square test and Student's t-test were used to compare the data. RESULTS: The total intraoperative fentanyl consumption was significantly less in the PIFB group (587.8 ± 165.7 µg) than in the NPIFB group (935.6 ± 157.2 µg) (P < 0.0001). The postoperative pain scores, the need for rescue fentanyl, and the incidence of nausea and vomiting at different time points were significantly lower in the PIFB group. Patients in the PIFB group cooperated well with incentive spirometry exercises at various time points. There was no difference in sedation score at different time points between the two groups. No complications were noted in either group. CONCLUSIONS: Ultrasound-guided PIFB is very effective as a pre-emptive analgesic adjunct for sternotomy pain in patients undergoing cardiac surgery.