• Lukas Gasteiger, Anna Fiala, Felix Naegele, Elisabeth Gasteiger, Anna Seisl, Nikolaos Bonaros, Peter Mair, Corinna Velik-Salchner, Johannes Holfeld, Daniel Höfer, and Ottokar Stundner.
• Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
• J. Cardiothorac. Vasc. Anesth. 2024 Dec 1; 38 (12): 297329812973-2981.

ObjectiveAcute postoperative pain remains a major obstacle in minimally invasive cardiac surgery (MICS). Evidence of the analgesic benefit of chest wall blocks is limited. This study was designed to assess the influence of combined pectoserratus plane block plus interpectoral plane block (PSPB + IPPB) on postoperative pain and the overall benefit of analgesia compared with placebo.DesignA prospective, randomized, triple-blinded study was conducted.SettingThe setting was the operating room and intensive care unit of a university hospital.ParticipantsA total of 60 patients undergoing elective right-lateral MICS were enrolled.InterventionsPatients were randomly assigned to preoperative PSPB + IPPB with 30 mL of ropivacaine 0.5% or saline.Measurements And Main ResultsThe primary endpoint was total intravenous morphine milligram equivalents administered in the first 24 hours after extubation. Secondary endpoints included the Overall Benefit of Analgesia Score (OBAS) at 24 hours after extubation and repeated Visual Analogue Scale (VAS). Values for intravenous morphine milligram equivalents administered in the first 24 hours after extubation were significantly lower (median [interquartile range]: 4.2 mg [2.1 - 7.9] v 8.3 mg [4.2 - 15.7], p = 0.025; mean difference: 6.7 mg [0.94 - 12 mg], p = 0.024, Cohen's d: 0.64 [0.09 - 1.2]). Moreover, OBAS at 24 hours and VAS after extubation were significantly lower (4.0 [3.0 - 6.0] v 7.0 [3.0 - 9.0], p = 0.043; 0.0 cm [0.0 - 2.0] v 1.5 cm [0.3 - 3.0], p = 0.030). VAS did not differ between groups at later points.ConclusionsPreoperative PSPB + IPPB reduced 24-hour postextubation opioid consumption, pain at extubation, and OBAS. Given its low risk and expedient placement, it could be a helpful addition to MICS protocols. Future studies should evaluate these findings in multicenter settings and further elucidate the optimal timing of block placement.Copyright © 2024. Published by Elsevier Inc.

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