Comparative Efficacy of Pecto-Intercostal Facial Plane Block vs Transversus Thoracic Facial Plane Block Combined with Rectus Sheath Block for Post-Sternotomy Analgesia: A Prospective Randomized Controlled Trial
- 1Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India
Abstract
Background:: Ultrasound-guided facial plane blocks are central to enhanced recovery after cardiac surgery (ERACS) protocols, yet evidence comparing pecto-intercostal facial plane block (PIFB) and transversus thoracic facial plane block (TTPB) with rectus sheath block (RSB) remains limited.
Methods:: This prospective, randomized, controlled trial enrolled 100 adult patients (ASA II–III) undergoing elective median sternotomy at a tertiary care hospital in South India. Patients received standardized general anesthesia and were randomized to bilateral PIFB or TTPB (20 mL 0.25% bupivacaine + 4 mg dexamethasone per side) with RSB after cardiopulmonary bypass. The primary outcome was 24-hour postoperative fentanyl consumption. Secondary outcomes included visual analog scale (VAS) pain scores at 0, 3-, 6-, 12-, and 24-hours post-extubation, rescue analgesia, extubation timing, ICU/hospital stay, and complications.
Results:: A total of 96 patients completed analysis (PIFB: n = 47; TTPB: n = 49). Mean 24-hour fentanyl consumption was 267.23 ± 92.54 µg (PIFB) vs 297.18 ± 88.09 µg (TTPB), mean difference − 29.95 µg (95% confidence interval: −66.60 to 6.70; P = 0.108). VAS scores showed no significant between-group differences (P > 0.05). Rescue analgesia rates were similar, with 84% and 90% not requiring additional opioids. Four PIFB patients (8%) stayed intubated >24 hours due to cardiac issues, vs none in the TTPB group (P = 0.121).
Conclusion:: This trial found no significant difference in opioid consumption or pain scores between PIFB + RSB and TTPB + RSB for post-sternotomy analgesia. Both techniques were safe within ERACS protocols. Larger noninferiority trials are needed before establishing equivalence or recommending one technique over another.
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BibTeX
@article{gupta2026comparative,
title = {{Comparative Efficacy of Pecto-Intercostal Facial Plane Block vs Transversus Thoracic Facial Plane Block Combined with Rectus Sheath Block for Post-Sternotomy Analgesia: A Prospective Randomized Controlled Trial}},
author = {Priya Gupta and Ravikanth Pula and Venu Polapally and Sunanda Gooty and Varsha Krosuri and Nagarjuna Thakur and Ramachandran Gopinath},
journal = {Annals of Cardiac Anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/aca.aca_112_26},
url = {https://doi.org/10.4103/aca.aca_112_26},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Comparative Efficacy of Pecto-Intercostal Facial Plane Block vs Transversus Thoracic Facial Plane Block Combined with Rectus Sheath Block for Post-Sternotomy Analgesia: A Prospective Randomized Controlled Trial
AU - Priya Gupta
AU - Ravikanth Pula
AU - Venu Polapally
AU - Sunanda Gooty
AU - Varsha Krosuri
AU - Nagarjuna Thakur
AU - Ramachandran Gopinath
PY - 2026
DA - 2026/10/12
JO - Annals of Cardiac Anaesthesia
DO - 10.4103/aca.aca_112_26
UR - https://doi.org/10.4103/aca.aca_112_26
AB - Background:: Ultrasound-guided facial plane blocks are central to enhanced recovery after cardiac surgery (ERACS) protocols, yet evidence comparing pecto-intercostal facial plane block (PIFB) and transversus thoracic facial plane block (TTPB) with rectus sheath block (RSB) remains limited. Methods:: This prospective, randomized, controlled trial enrolled 100 adult patients (ASA II–III) undergoing elective median sternotomy at a tertiary care hospital in South India. Patients received standardized general anesthesia and were randomized to bilateral PIFB or TTPB (20 mL 0.25% bupivacaine + 4 mg dexamethasone per side) with RSB after cardiopulmonary bypass. The primary outcome was 24-hour postoperative fentanyl consumption. Secondary outcomes included visual analog scale (VAS) pain scores at 0, 3-, 6-, 12-, and 24-hours post-extubation, rescue analgesia, extubation timing, ICU/hospital stay, and complications. Results:: A total of 96 patients completed analysis (PIFB: n = 47; TTPB: n = 49). Mean 24-hour fentanyl consumption was 267.23 ± 92.54 µg (PIFB) vs 297.18 ± 88.09 µg (TTPB), mean difference − 29.95 µg (95% confidence interval: −66.60 to 6.70; P = 0.108). VAS scores showed no significant between-group differences (P > 0.05). Rescue analgesia rates were similar, with 84% and 90% not requiring additional opioids. Four PIFB patients (8%) stayed intubated >24 hours due to cardiac issues, vs none in the TTPB group (P = 0.121). Conclusion:: This trial found no significant difference in opioid consumption or pain scores between PIFB + RSB and TTPB + RSB for post-sternotomy analgesia. Both techniques were safe within ERACS protocols. Larger noninferiority trials are needed before establishing equivalence or recommending one technique over another.
SN - 0971-9784
SN - 0974-5181
ER -