Tanvi Khera, MD- Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surge...

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Dr. Tanvi Khera joined the team at Beth Israel Deaconess Medical Center as a Clinical Research Fellow in July 2019 after completing her residency in anesthesiology and critical care at Government Medical College in Chandigarh, India. She is collaborating with the cardiac anesthesiology research team on studies aimed at determining the cause-and-effect relationship between post-operative condition and cognitive dysfunction, as well as pursuing her academic anesthesiology interests under Dr. Subramaniam's mentoring. Improved perioperative patient outcomes, pain management, and the development of safe anesthesia techniques are among her research interests. In this video Dr. Khera discusses Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial.

Link to Abstract-

The goal of this study was to see how pecto-intercostal fascial plane block (PIFB) affected postoperative opioid requirements, pain scores, ICU and hospital stays, and the incidence of postoperative delirium in cardiac surgery patients.
Design: A prospective, single-center, randomized (1:1), quadruple-blinded, placebo-controlled trial was conducted.
Setting: A single, tertiary-care facility.

The study included 80 adult cardiac surgery patients (age >18 years) who needed a median sternotomy.

On postoperative days 0 and 1, patients were randomly randomized to undergo ultrasound-guided PIFB with 0.25 percent bupivacaine or placebo.

Measurements and Main Results: The mean age in the bupivacaine group was 65.78 8.73, while in the placebo group it was 65.70 9.86 (p = 0.573). Patients who received PIFB with 0.25 percent bupivacaine had a statistically significant decrease in visual analog scale scores (4.8 2.7 v 5.1 2.6; p 0.001), but the 48-hour cumulative opioid requirement calculated in morphine milligram equivalents was similar (40.8 22.4 mg v 49.1 26.9 mg; p = 0.14). The incidence of postoperative delirium did not differ between the groups assessed by the 3-minute diagnostic Confusion Assessment Method (3/40 [7.5 percent] v 5/40 [12.5%] placebo; p = 0.45).

Conclusion: Patients who got PIFB with bupivacaine had a lower cumulative opioid intake after surgery, although this difference was not statistically significant. The PIFB may be performed safely in this population, based on the low incidence of complications and improvements in visual analog scale pain scores, and justifies further research with a larger sample size.