The effect of ultrasound-guided bilateral single shot pecto-intercostal plane block on recovery after on-pump coronary bypass graft surgery, randomized controlled trial

Abstract

Background: Fast-track anaesthesia and ultra-fast track anaesthesia are techniques used in cardiac anaesthesia aiming for early extubation in the intensive care unit. This study assessed the efficacy and safety of pecto-intercostal plane blocks (PIFB) guided by ultrasonography following on-pump coronary artery bypass graft (CABG) surgery.Methods: 40 Patients of both genders aged > 40 years scheduled for on-pump CABG surgery were randomly distributed either; Group I (Control group): bilateral PIFB with normal saline (1 ml), Group II (PIFB group): bilateral PIFB with local anaesthetics. The extubation time was the primary outcome while the secondary outcome were postoperative pain scores, intraoperative and postoperative opioid consumption, the ICU stay duration and the incidence of postoperative complications.Results: There were statistically significant reductions in the extubation time, ICU length stay, intraoperative fentanyl, and postoperative morphine consumption in the PIFB group compared with the control group (P value ? 0.05). Pain scores were lower in PIFB group at 2, 4, 12, 16, 20, and 24 h after extubation than Control group. Compared to the control group, the PIFB group experienced a significantly longer time to first morphine requirement as rescue analgesic analgesia. Between the two groups, there were insignificant differences in the frequency of complications, diaphragmatic dysfunction, postoperative reintubation, and 30-day mortality. Conclusion: The intraoperative PIFB in patients scheduled for on-pump CABG surgery shortened the extubation time and the ICU length, decreased intraoperative fentanyl and postoperative morphine consumption and postoperative pain scores, prolonged 1st time of rescue analgesia.Trial registration: ClinicalTrials.gov ID: NCT04343105 at the date of May 2020.