Effectiveness of Pecto-Intercostal Fascia Plane Block in Reducing Total Postoperative Opioid Consumption in Cardiac Surgery Involving Sternotomy: A Meta-Analysis.

Abstract: The pecto-intercostal fascia plane block (PIFB) is gaining recognition for its potential to reduce postoperative opioid use after cardiac surgery. This study aimed to evaluate the effectiveness of PIFB compared with conventional intravenous regimens in reducing total postoperative opioid consumption in patients undergoing cardiac surgery involving sternotomy. A meta-analysis of relevant studies, published up to August 13, 2024, retrieved from the PubMed and CENTRAL databases was performed. The inclusion criteria were studies involving a superficial parasternal block or PIFB for patients undergoing cardiac surgery involving sternotomy. Studies comparing PIFB with other blocks or local anesthetic regimens were excluded. Data analysis was performed using an inverse variance random-effects model using RevMan 5.4.1 software, with the effect measure expressed as standardized mean difference (SMD) to account for the different opioids used. Of 88 studies retrieved in the literature search, 16 fulfilled the inclusion criteria [ten ultrasound (US)-guided and six non-US-guided]. PIFB significantly reduced total opioid consumption [SMD -1.55 (95% CI -2.15 to -0.95); P < 0.001] and time to extubation [SMD -1.22 (95% CI -2.05 to -0.38); P < 0.001]. A subgroup analysis of multiple- versus single-shot injections yielded consistent results. Analyses including only US-guided PIFB revealed consistent reductions in total opioid consumption [SMD -1.18 (95% CI -1.79 to -0.56); P < 0.001] and time to extubation [SMD -0.82 (95% CI -1.01 to -0.63); P < 0.001]. PIFB effectively reduced opioid consumption and shortened postoperative time to extubation in cardiac surgery involving sternotomy.