• Tanvi Khera, Kadhiresan R Murugappan, Akiva Leibowitz, Noa Bareli, Puja Shankar, Scott Gilleland, Katerina Wilson, Achikam Oren-Grinberg, Victor Novack, Senthilnathan Venkatachalam, Valluvan Rangasamy, and Balachundhar Subramaniam.
• Center for Anesthesia and Research Excellence, Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
• J. Cardiothorac. Vasc. Anesth. 2021 Mar 1; 35 (3): 896-903.

ObjectiveTo explore the effect of pecto-intercostal fascial plane block (PIFB) on postoperative opioid requirements, pain scores, lengths of intensive care unit and hospital stays and incidence of postoperative delirium in cardiac surgical patients.DesignSingle- center, prospective, randomized (1:1), quadruple- blinded, placebo-controlled trial.SettingSingle center, tertiary- care center.ParticipantsThe study comprised 80 adult cardiac surgical patients (age >18 y) requiring median sternotomy.InterventionPatients were randomly assigned to receive ultrasound-guided PIFB, with either 0.25% bupivacaine or placebo, on postoperative days 0 and 1.Measurements And Main ResultsOf the 80 patients randomized, the mean age was 65.78 ± 8.73 in the bupivacaine group and 65.70 ± 9.86 in the placebo group (p = 0.573). Patients receiving PIFB with 0.25% bupivacaine showed a statistically significant reduction in visual analog scale scores (4.8 ± 2.7 v 5.1 ± 2.6; p < 0.001), but the 48-hour cumulative opioid requirement computed as morphine milligram equivalents was similar (40.8 ± 22.4 mg v 49.1 ± 26.9 mg; p = 0.14). There was no difference in the incidence of postoperative delirium between the groups evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40 [7.5%] v 5/40 [12.5%] placebo; p = 0.45).ConclusionPatients who received PIFB with bupivacaine showed a decline in cumulative opioid consumption postoperatively, but this difference between the groups was not statistically significant. Low incidence of complications and improvement in visual analog scale pain scores suggested that the PIFB can be performed safely in this population and warrants additional studies with a larger sample size.Copyright © 2020 Elsevier Inc. All rights reserved.

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