Impact of pecto-intercostal fascial block on postoperative fatigue in elderly patients undergoing off-pump coronary artery bypass grafting: a randomized clinical trial.

Abstract

Background: Postoperative fatigue syndrome (POFS) is a common yet often under-recognized consequence of surgical interventions, particularly in cardiac surgery. POFS is associated with prolonged recovery times, extended hospital stays, and increased healthcare costs. Current strategies for preventing POFS have demonstrated limited success. This study aims to evaluate the impact of pecto-intercostal fascial block (PIFB) on the incidence of POFS in elderly patients undergoing off-pumpcoronary artery bypass graft (CABG) surgery.

Methods: In this randomized controlled trial, 110 elderly patients scheduled for off-pump CABG surgery were randomly assigned to either the PIFB group (n = 55; 0.4% ropivacaine) or the control group (n = 55; normal saline). The primary outcome was the incidence of POFS, which was assessed using the ICFS-10 scale. Secondary outcomes included postoperative pain scores, opioid consumption, extubation time, duration of ICU and hospital stay, and Quality of Recovery (QoR-15) scores.

Results: The incidence of POFS was significantly lower in the PIFB group compared to the control group on postoperative days 1 (69.0% vs. 92.7%, P = 0.004), 3 (63.6% vs. 83.6%, P = 0.030), and 5 (52.7% vs. 72.7%, P = 0.048), with no significant differences observed by day 7 and 8 weeks. Pain scores were also markedly lower in the PIFB group at three time points: immediately after extubation, 12 hours post-surgery, and 24 hours post-surgery (P < 0.001, P < 0.001, and P = 0.002, respectively). Furthermore, opioid consumption was reduced by an average of 11.1 mg (P < 0.001). Patients in the PIFB group experienced significantly shorter extubation times (5.5 ± 1.8 hours vs. 8.6 ± 2.1 hours, P < 0.001), ICU stays (31.8 ± 7.3 hours vs. 39.4 ± 7.5 hours, P < 0.001), and hospital stays (8.2 ± 1.1 days vs. 8.8 ± 1.2 days, P = 0.007). QoR-15 scores were significantly higher in the PIFB group on postoperative days 1, 3, and 5 (P < 0.001, P = 0.003, and P = 0.037, respectively). Notably, no PIFB-related adverse events were reported in either group.

Conclusions: PIFB significantly alleviated early POFS, enhanced pain management, reduced opioid consumption, and accelerated recovery, thereby improving the overall quality of recovery in elderly patients undergoing off-pump CABG.