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Pecto-Intercostal Fascial Block in Cardiac Surgical Patients
How to cite this article: Magoon R, Jose J, Kaushal B. Pecto-intercostal fascial block in cardiac surgical patients. J Card Crit Care TSS 2023;7:100-1.
Despite an ever-growing motivation towards minimal invasion in cardiac surgery, the majority of open-heart surgery continues to employ a median sternotomy incision which results in significant acute postoperative pain with subsequently enhanced predisposition to persistent post-sternotomy pain (PSP).[1-3]
Ultrasound (USG)-guided pecto-intercostal fascial block (PIFB) has been recently proposed to effectively manage the median sternotomy pain wherein García Simón and Fajardo Perez suggest a decreased risk of major complications (including, vascular injury and pneumothorax) with PIFB as opposed to the transversus thoracis muscle plane block.[1-4]
We often perform a bilateral PIFB for our cardiac surgical patients undergoing median sternotomy, mostly after induction of general anesthesia. With the patient in a supine position, a high-frequency L 12–3 MHz linear USG probe (EPIQ7C, PHILIPS, Holland) is placed 2–3 cm lateral to the corresponding sternal edge in the 4th intercostal space [Figure 1a]. Using a 21-gauge ×100 mm Stimuplex A block needle (B. Braun, Melsungen, Germany), an in-plane approach is employed to reach the target PIFB between the pectoralis major and external intercostal muscles [Figure 1b]. Following hydro-dissection with saline to confirm the desired plane for local anesthetic (LA) injection [Figure 1c], 20 mL of dilute concentrations of 0.25–0.3% ropivacaine is injected on each side, which tends to be within the safe limits of the LA dose as per the body weight of the patient.
Meanwhile, we practice a single-injection PIFB (akin to research groups like Wang et al.) and rely on the LA spread visualized under USG-guidance, independent researchers also employ 2–3-injection PIFB technique equally dividing the LA volumes accordingly.[1,3]
Nonetheless, recent literature on the efficacy-safety of PIFB is encouraging wherein one can achieve adequate post-sternotomy pain relief with an acceptable degree of opioid-sparing closely governed by institutional analgesic practices.[1-5]
Interestingly, Sahoo et al. report a seminal use of PIFB in a 63-year-old lady suffering from severe persistent PSP following coronary artery bypass grafting, propounding the role of the former in chronic pain settings as well.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
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