Peripheral Nerve Blocks for Enhanced Recovery in Cardiac Surgery: A Retrospective Observational Study

This retrospective observational study evaluates the effect of incorporating peripheral nerve blocks (PNBs) into an established enhanced recovery after surgery (ERAS) protocol. The PNBs used included pecto-intercostal fascial block (PIFB) and rectus sheath block, performed under ultrasound guidance with the administration of a long-acting local anesthetic, Ropivacaine. Both patient and process outcomes were assessed to determine the effect PNBs have as part of an ERAS protocol.

Adult patients undergoing cardiac surgery with midline sternotomy who were expected to be extubated within 6 hours of arrival to the intensive care unit (ICU) between October 2022 and June 2023 were included. Patients were dichotomized by whether they received a PNB or not. Outcomes included opioid consumption as measured by morphine milligram equivalents (MME), ICU length of stay (LOS), postoperative mobility, and the incidence of postoperative atrial fibrillation (POAF).

431 patients were included: 170 (39.4%) received a PNB, and 243 (60.6%) did not (non-PNB group). Patients who received a PNB required a significantly shorter time to achieve first ambulation as measured from bed to chair (15.2 hours PNB vs. 18.5 hours non-PNB, P = 0.037), significantly lower rates of atrial fibrillation (26.5% PNB vs. 32.9% non-PNB, P = 0.045), shorter LOS in the ICU (44.4 hours PNB vs. 49.7 hours non-PNB, P = 0.024).

Incorporating PNBs as part of a multimodal analgesic strategy for patients undergoing cardiac surgical procedures is associated with improved patient and process outcomes. Our finding of a reduction in POAF warrants further investigation in an adequately powered randomized controlled trial.