Journal of cardiothoracic and vascular anesthesia · 2026
Effect of Bilateral Pectointercostal Fascial Plane Block on Chronic Postsurgical Pain After Coronary Artery Bypass Grafting: A Randomized Clinical Trial.
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Mutluay Yusuf Salih, Kozanhan Betul, Yildiz Munise, Sari Sinem, Mermer Hasan Alp, Tutar Mahmut Sami
Аннотация
OBJECTIVES: To evaluate whether the bilateral pectointercostal fascial plane (PIF) block reduces clinically relevant chronic postsurgical pain (CPSP) 3 months after coronary artery bypass grafting (CABG).
DESIGN: Single-center, prospective, randomized, controlled trial with blinded postoperative outcome assessment.
SETTING: Tertiary referral hospital.
PARTICIPANTS: Fifty adults undergoing elective CABG via median sternotomy.
INTERVENTIONS: Patients were randomized 1:1 to bilateral ultrasound-guided PIF block with 0.25% bupivacaine (n = 25) or standard care without block (n = 25).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was clinically relevant CPSP at 3 months, defined by International Classifications of Diseases, 11th Revision (ICD-11), criteria plus functional interference on the Brief Pain Inventory. Secondary outcomes included 72-hour morphine consumption, acute postoperative pain scores, neuropathic pain features, and quality of life. CPSP occurred in 28% of the PIF group (7/25) and 48% of controls (12/25) (odds ratio, 0.42; 95% confidence interval, 0.13-1.36; p = 0.145). In exploratory secondary analyses, acute pain scores at rest and with movement were lower in the PIF group during the first 72 postoperative hours (all p < 0.001). Cumulative 72-hour morphine consumption was lower with PIF block (34 mg [29-37 mg] vs 42 [41.0-44.5 mg]; nominal p < 0.001). No block-related complications occurred.
CONCLUSIONS: Bilateral PIF block did not demonstrate a statistically significant decrease in clinically relevant CPSP at 3 months after CABG. Although PIF block was associated with lower acute postoperative pain scores and lower morphine consumption, these secondary findings should be interpreted as exploratory. The role of PIF block in chronic pain prevention remains uncertain.
DESIGN: Single-center, prospective, randomized, controlled trial with blinded postoperative outcome assessment.
SETTING: Tertiary referral hospital.
PARTICIPANTS: Fifty adults undergoing elective CABG via median sternotomy.
INTERVENTIONS: Patients were randomized 1:1 to bilateral ultrasound-guided PIF block with 0.25% bupivacaine (n = 25) or standard care without block (n = 25).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was clinically relevant CPSP at 3 months, defined by International Classifications of Diseases, 11th Revision (ICD-11), criteria plus functional interference on the Brief Pain Inventory. Secondary outcomes included 72-hour morphine consumption, acute postoperative pain scores, neuropathic pain features, and quality of life. CPSP occurred in 28% of the PIF group (7/25) and 48% of controls (12/25) (odds ratio, 0.42; 95% confidence interval, 0.13-1.36; p = 0.145). In exploratory secondary analyses, acute pain scores at rest and with movement were lower in the PIF group during the first 72 postoperative hours (all p < 0.001). Cumulative 72-hour morphine consumption was lower with PIF block (34 mg [29-37 mg] vs 42 [41.0-44.5 mg]; nominal p < 0.001). No block-related complications occurred.
CONCLUSIONS: Bilateral PIF block did not demonstrate a statistically significant decrease in clinically relevant CPSP at 3 months after CABG. Although PIF block was associated with lower acute postoperative pain scores and lower morphine consumption, these secondary findings should be interpreted as exploratory. The role of PIF block in chronic pain prevention remains uncertain.