307: Pecto-Intercostal Fascial Plane Block for Intraoperative Pain Control in Cardiac Surgeries

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pain in Special Populations

Background and Aims: Median sternotomy produces significant nociceptive stimulation during cardiac surgery and may lead to marked intraoperative hemodynamic responses requiring additional opioid administration. The pecto-intercostal fascial plane (PIFP) block is a novel ultrasound-guided regional technique that provides analgesia to the anterior chest wall. This study aimed to evaluate the effect of bilateral PIFP block on intraoperative opioid consumption and hemodynamic responses to sternotomy in adult cardiac surgical patients.

Methods: Single-center prospective randomized controlled study conducted at the Cardiothoracic Unit, National Hospital Kandy, Sri Lanka. Fifty adult patients undergoing elective cardiac surgery (CABG and valve procedures) via median sternotomy were recruited and randomized equally into two groups (n = 25 per group). After induction of standardized general anesthesia, patients in the PIFP group received bilateral ultrasound-guided pecto-intercostal fascial plane blocks using 20 mL of 0.25% bupivacaine on each side. The control group received no regional block. All patients received standardized intraoperative opioid-based anesthesia.

Results: The primary outcome was intraoperative opioid requirement and hemodynamic response at the time of sternotomy. Hemodynamic variables (systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate) were recorded at baseline and immediately following sternotomy.

The control group demonstrated a significant increase in systolic, diastolic, and mean arterial pressures, as well as heart rate at sternotomy compared with baseline (p < 0.05). In contrast, the PIFP group showed minimal variation from baseline values, with significantly attenuated hemodynamic responses compared with the control group (between-group comparison p < 0.05).

Conclusions: Bilateral ultrasound-guided pecto-intercostal fascial plane block significantly attenuates hemodynamic responses to sternotomy and reduces intraoperative opioid requirements in adult cardiac surgical patients. Incorporation of PIFP block into multimodal analgesia protocols may enhance intraoperative stability and contribute to opioid minimization strategies in cardiac surgery.

Further larger-scale studies are required to evaluate its impact on total perioperative opioid consumption, tracheal extubation time, postoperative pain scores, and enhanced recovery outcomes.

References: 1. Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118:391–396.
2. Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestfeld S, Beckman D. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004;13:116–125.
3. Gélinas C. Management of pain in cardiac surgery ICU patients: Have we improved over time? Intensive Crit Care Nurs. 2007;23:298–303.

Presenting Author: Roshana Mallawaarachchi
Submitting Author: Roshana Mallawaarachchi

Senior Author: Roshana Mallawaarachchi

IASP 2026 Global Year theme of Neuropathic Pain: No

• Roshana Mallawaarachchi: MBBS, MD - National Hospital, Kandy
• Muditha Lansakara: MBBS, MD, MRCS - National Hospital Kandy