Fascial Plane Blocks In Cardiac Surgery

The Effect Of Combined Rectus-Intercostal Fascial Plane Block Or Rectus Sheatf Block With A Pectoral-Intercostal Fascial Plane Block In Cardiac Surgery On Postoperative Opioid Consumption, Quality Of Recovery, And Chronic Pain: A Prospective, Observational Study

The aim of the present study is to evaluate the effects of the recto-intercostal fascial plane block (RIFPB) or the rectus sheath block (RSB) combined with the pectoral-intercostal fascial plane block (PIFPB) on postoperative analgesia in patients undergoing cardiac surgery.

Effective pain management after cardiac surgery is crucial in improving patient outcomes, promoting early postoperative mobilisation and minimising the risk of postoperative respiratory complications. It has indeed been shown that these patients experience moderate to severe pain during the postoperative period. While opioids are commonly used in perioperative care, they are also linked to adverse opioid-related effects. The literature suggests selecting an analgesic treatment strategy that avoids opioid-based analgesia for patients undergoing cardiac surgery during the postoperative period. Regional anaesthesia techniques are widely used in cardiac surgery patients to address concerns about the risk of myocardial and/or renal damage associated with non-steroidal anti-inflammatory drugs (NSAIDs), reduce the incidence of potential opioid-related side effects, lower the high risk of delirium and improve patient rehabilitation. However, only a limited number of studies have demonstrated the effects of the recto-intercostal fascial plane block (RIFPB) or the rectus sheath block (RSB) combined with the pectoral-intercostal fascial plane block (PIFPB) on postoperative analgesia in cardiac surgery patients. Therefore, the present study aims to evaluate the effects of the RIFPB or the RSB combined with the PIFPB on postoperative analgesia in patients undergoing cardiac surgery.

Inclusion Criteria:

• elective cardiac surgery planned
• over 18 years, adult
• American Society of Anaesthesiology (ASA) score I-III

Exclusion Criteria:

• under 18 years of age,
• ASA IV and above,
• contraindications for the block application
• history of cardiac surgery,
• reoperated due to surgery-related complications after emergency surgery or postoperative elective surgery,
• off-pump cardiac surgery or minimally invasive cardiac surgery
• unable to be extubated in the intensive care unit at 24 hours postoperatively
• history of chronic pain treatment
• chronic alcoholism and substance abuse
• declining to give written informed consent