• Lu Wang, Luyang Jiang, Bailin Jiang, Ling Xin, Miao He, Wei Yang, Zhou Zhao, and Yi Feng.
• Department of Anesthesiology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
• BMC Anesthesiol. 2023 Mar 23; 23 (1): 9090.

BackgroundPecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, but many patients complain of severe drainage pain that cannot be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, but whether PIFB combined with RSB can achieve better analgesia is uncertain.MethodsThis was a single-center randomized controlled trial at Peking University People's Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB + RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 h after surgery. Secondary outcomes included opioid consumption within 48 h, postoperative pain scores, time to extubation, and length of stay in the hospital. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α before and the first 24 h after surgery were measured.ResultsA total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 h after surgery was 2.33 ± 1.77 mg in the PIFB + RSB group vs 3.81 ± 2.24 mg in the PIFB group (p = 0.010). Opioid consumption within 48 h after surgery was also reduced in the PIFB + RSB group (4.71 ± 2.71 mg vs 7.25 ± 3.76 mg, p = 0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, or the levels of IL-6, IL-10 and TNF-α between the two groups.ConclusionsThe combination of PIFB and RSB reduced postoperative intravenous opioid consumption until 48 h after cardiac surgery.Trial RegistrationThis trial is registered at the Chinese Clinical Trial Registry ( www.chictr.org.cn , ChiCTR2200062017) on 19/07/2022.© 2023. The Author(s).

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