Pecto-intercostal fascial plane block with or without rectus sheath block in cardiac surgery: a prospective, randomized, double-blind placebo-controlled study.

Background: Median sternotomy and chest tube sites drive pain following cardiac surgery. Prior research has demonstrated that pecto-intercostal fascial plane blocks (PIFBs) reduce median sternotomy pain after cardiac surgery. Prior studies examining the addition of a rectus sheath block (RSB) to localize the insertion site of subxiphoid chest tubes have had mixed results.

Methods: In this single-center, randomized, double-blind, placebo-controlled trial, 62 patients undergoing cardiac surgery with median sternotomy and subxiphoid chest tubes were randomized to receive PIFB and RSB with local anesthetic versus PIFB with local anesthetic and RSB with saline placebo. The primary outcome was pain at rest and with deep breathing in the first 24 hours after surgery. Secondary outcomes included total opioid consumption at 24 and 48 hours, performance on incentive spirometry in the first 24 hours, time to extubation, hospital and intensive care unit length of stay, and Quality of Recovery-15 score.

Results: There was no statistically significant difference between groups for the primary outcome, with mean area under the curve (AUC) for pain at rest in the first 24 hours 93.37±41.38 (sample mean±sample SD) in the placebo group versus 86.11±42.78 in the bupivacaine group (p=0.51), and mean AUC for pain with deep breathing 135.55±43.74 in the placebo group versus 128.78±47.08 in the bupivacaine group (p=0.57). There were no differences in secondary outcomes between groups.

Conclusions: Adding bilateral RSB to bilateral PIFB did not improve pain control or other outcomes for patients undergoing cardiac surgery.