Additive Regional Fascial Plain Blocks to Pectointercostal Fascial Block for Postoperative Pain Management After Cardiac Surgery: a Randomized Controlled Trial

Summary

Acute postoperative pain is severe in cardiac patients undergoing sternotomy, and pain intensity is more severe than expected. Many patients referred to tube insertion as the most painful site after coronary artery bypass surgery. (6) Rectus sheath block (RSB) can offer somatic analgesia for midline incisions. (7) It has been verified to manage subxiphoid drainage pain effectively and safely for cardiac surgery patients. Another intervention, External oblique intercoastal plane block (EOIPB) is given at the mid-clavicular line and may block the intercostal nerve's anterior and lateral branches. Anesthesia is provided between the external oblique and intercostal nerves. This allows analgesia of the anterior upper abdominal wall between T6-T10 dermatomes in the anterior axillary line and T6-T9 dermatomes in the midline. It blocks the lateral and anterior branches of T6-T10 intercostal nerves.

Conditions

• Postoperative Pain Management

Interventions

PROCEDURE

PIFPB block

The ultrasound probe will be positioned parallel and 2-3 cm lateral from the midline in the 4th or 5th intercostal space. The needle will be inserted in-plane in a cauda-cranial direction until the tip of the needle reaches the plane of the fascia between the pectoralis major muscle and the external intercostal muscles. A 20 ml volume of bupivacaine 0.25% will be injected on each side.

PROCEDURE

PIRSB Block

After the PIFPB is performed with the same position and probe, a bilateral posterior rectus sheath block (PRSB) will be conducted. The probe will be placed 2-3 cm next to the xiphoid in the epigastric region and parallel to the costal margin. The needle will be inserted into the plane between the rectus abdominal muscle and its posterior sheath. After verifying needle placement, 10 ml of bupivacaine 0.25% will be injected on each side.

PROCEDURE

PIEOB block

After the PIFPB is performed with the same position and probe, an external oblique block will be used to place the linear array ultrasound probe between the midclavicular line and the anterior axillary line at the level of the 6th rib, with the direction mark pointing to the cephalad. The probe will be rotated on the slightly medial cranial end, and the caudal end will be lateral to produce a mesial sagittal oblique view and a short-axis view of the ribs. The following structures will be identified from superficial to deep layers: subcutaneous tissue, external oblique muscle, intercostal muscles, pleura, and lung. After determining the thoracic fascial space between the external oblique muscle and the intercostal muscles, bupivacaine 20 mL will be slowly injected into the space with a nerve block needle at the head side of the 6th rib horizontally near the mid axillary line. The block will be repeated in the same way on the other side.

Sponsors & Collaborators

• Alexandria University

  lead OTHER

Principal Investigators

• Islam Elbardan, Dr · University of Alexandria

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-03-04

Primary Completion

2025-08-30

Completion

2025-08-30

Countries

• Egypt

Study Locations