Efficacy of ultrasound-guided, single-level, pectointercostal facial block (PIFB) for postoperative analgesia after sternotomy in paediatric cardiac surgery: A randomised controlled trial.

Abstract

Background and aims: Children undergoing median sternotomy often face moderate to severe postoperative discomfort, along with various other complications. Under ultrasound guidance, a pectointercostal fascial block (PIFB) might relieve this pain. This research aimed to assess the effectiveness of a single-level PIFB for poststernotomy analgesia in children.

Methods: Sixty children scheduled for elective open-heart surgery through a midline sternotomy were randomly assigned to a pectointercostal group (PI) that was administered bilateral PIFB or a control group (C) that did not receive any intervention. The primary outcome was the postoperative Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale score at 6 h. The analysis employed Student's t-test for variables with a normal distribution and Chi-squared test/Fisher's exact test for categorical data, with a significance threshold established at a P value < 0.05.

Results: Intraoperative PIFB decreased the total dose of fentanyl (P < 0.001) while maintaining a favourable haemodynamic profile. Postoperative PIFB reduced pain scores (P < 0.001), as evidenced by a delayed initial request for rescue analgesia (P < 0.001), reduced morphine consumption (P < 0.001) and improved predictive indicators such as extubation time (P < 0.001) and intensive care unit stay (P = 0.008) without complications.

Conclusion: Single-level, ultrasound-guided PIFB provides good analgesia and hastens recovery in children's open-heart surgery through a midline sternotomy.