Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial

Tanvi Khera, Kadhiresan R. Murugappan, Akiva Leibowitz, Noa Bareli, Puja Shankar, Scott Gilleland, Katerina Wilson, Achikam Oren-Grinberg, Victor Novack, Senthilnathan Venkatachalam, Valluvan Rangasamy, Balachundhar Subramaniam

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Objective: To explore the effect of pecto-intercostal fascial plane block (PIFB) on postoperative opioid requirements, pain scores, lengths of intensive care unit and hospital stays and incidence of postoperative delirium in cardiac surgical patients. Design: Single- center, prospective, randomized (1:1), quadruple- blinded, placebo-controlled trial. Setting: Single center, tertiary- care center. Participants: The study comprised 80 adult cardiac surgical patients (age >18 y) requiring median sternotomy. Intervention: Patients were randomly assigned to receive ultrasound-guided PIFB, with either 0.25% bupivacaine or placebo, on postoperative days 0 and 1. Measurements and Main Results: Of the 80 patients randomized, the mean age was 65.78 ± 8.73 in the bupivacaine group and 65.70 ± 9.86 in the placebo group (p = 0.573). Patients receiving PIFB with 0.25% bupivacaine showed a statistically significant reduction in visual analog scale scores (4.8 ± 2.7 v 5.1 ± 2.6; p < 0.001), but the 48-hour cumulative opioid requirement computed as morphine milligram equivalents was similar (40.8 ± 22.4 mg v 49.1 ± 26.9 mg; p = 0.14). There was no difference in the incidence of postoperative delirium between the groups evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40 [7.5%] v 5/40 [12.5%] placebo; p = 0.45). Conclusion: Patients who received PIFB with bupivacaine showed a decline in cumulative opioid consumption postoperatively, but this difference between the groups was not statistically significant. Low incidence of complications and improvement in visual analog scale pain scores suggested that the PIFB can be performed safely in this population and warrants additional studies with a larger sample size.

Original languageEnglish
Pages (from-to)896-903
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number3
StatePublished - 1 Mar 2021
Externally publishedYes


  • 3-minute diagnostic Confusion Assessment Method
  • 3D-CAM
  • PIFB
  • Pecto-intercostal fascial plane block
  • VAS
  • cardiac surgery
  • pain scores
  • postoperative delirium
  • visual analog scale

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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