Evaluation of the Effects of Pecto-Intercostal Fascial Plane Blocks on Extubation Time in Cardiac Surgery: A...

Background: Prolonged extubation and pain following cardiac surgery remain significant clinical challenges. The pecto-intercostal fascial plane block (PIFB) is an emerging regional anesthesia technique incorporated into multimodal analgesia protocols to reduce opioid consumption and facilitate early extubation. This study retrospectively evaluated extubation times, perioperative opioid consumption, and postoperative analgesic requirements in patients who underwent isolated open-heart surgery via median sternotomy, comparing those who received PIFB with those who did not. Methods: This retrospective single-center study included ninety-nine patients who underwent isolated on-pump coronary artery bypass graft surgery via median sternotomy between 1 June 2023 and 25 March 2024. The study included 46 patients who received PIFB (Group 1) and 53 patients who received no block (Group 2). Ultrasound-guided bilateral PIFB was performed after anesthesia induction, with a total of 40 mL administered to each side (30 mL 0.25% bupivacaine + 10 mL normal saline). Demographic data, perioperative data, extubation times, analgesic consumption, and complications were compared between groups. Results: Demographic data, EuroSCORE, body mass index, and ejection fraction were similar between groups. Perioperative opioid (fentanyl) consumption was statistically significantly higher in Group 2 (median 450 [IQR: 350-600] μg vs. 400 [IQR: 350-450] μg; p = 0.037). Extubation time was statistically significantly shorter in Group 1 compared to Group 2 (median 340 [IQR: 265-490] min vs. 495 [IQR: 420-555] min; p < 0.001). The number of patients requiring postoperative paracetamol and tramadol was statistically significantly lower in Group 1 (p = 0.015 and p < 0.001, respectively). No statistically significant difference was found between groups regarding chest drain removal, length of hospital stay, or ICU length of stay (p > 0.05). Mortality occurred in 1 patient in Group 1 and 2 patients in Group 2. Conclusions: PIFB application in isolated open-heart surgery performed via median sternotomy was associated with shorter extubation time and reduced perioperative fentanyl and postoperative analgesic consumption, without a statistically significant effect on hospital length of stay. Complication and mortality data are reported descriptively; the study does not have sufficient statistical power to draw inferences regarding safety outcomes.