Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Background: Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, while many patients complained of severe drainage pain which can’t be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods: : This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB+RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 hours after surgery. Secondary outcomes included opioid consumption within 48 hours, postoperative pain scores, time to extubation, length of stay in the hospital. Interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-a before and the first 24 hours after surgery were measured. Results: : A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 hours after surgery was 2.33±1.77 mg in the PIFB+RSB group vs 3.81±2.24 mg in the PIFB group (p=0.010). Opioid consumption within 48 hours after surgery was also reduced in the PIFB+RSB group (4.71±2.71 mg vs 7.25±3.76 mg, p=0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, the level of IL-6, IL-10 and TNF-a between two groups. Conclusions: : The combination of PIFB and RSB reduced postoperative intravenous opioid consumption and prolong the duration of single shot in cardiac surgery. Trial registration: This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.