Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery

Abstract

Background:Good postoperative analgesia in cardiac surgical patients helps in early recovery and ambulation. An alternative to parenteral, paravertebral, and thoracic epidural analgesia can be pectoralis nerve (Pecs) block, which is novel, less invasive regional analgesic technique.Aims:We hypothesized that Pecs block would provide superior postoperative analgesia for patients undergoing cardiac surgery through midline sternotomy compared to parenteral analgesia.Materials and Methods:Forty adult patients between the age groups of 25 and 65 years undergoing coronary artery bypass grafting or valve surgeries through midline sternotomy under general anesthesia were enrolled in the study. Patients were randomly allocated into two groups with 20 in each group. Group 1 patients did not receive Pecs block, whereas Group 2 patients received bilateral Pecs block postoperatively. Patients were extubated once they fulfilled extubation criteria. Ventilator duration was recorded. Patients were interrogated for pain by visual analog scale (VAS) scoring at rest and cough. Inspiratory flow rate was assessed using incentive spirometry.Results:Pecs group patients required lesser duration of ventilator support (P < 0.0001) in comparison to control group. Pain scores at rest and cough were significantly low in Pecs group at 0, 3, 6, 12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were comparable between two groups. Peak inspiratory flow rates were higher in Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P < 0.05). Thirty-four episodes of rescue analgesia were given in control group, whereas in Pecs group, there were only four episodes of rescue analgesia.Conclusion:Pecs block is technically simple and effective technique and can be used as part of multimodal analgesia in postoperative cardiac surgical patients for better patient comfort and outcome.

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries

“…Although the serratus plan block provides a larger area of ​​analgesia than PECS blocks, these blocks are ineffective in sternotomy pain in open-heart surgery. The nerves that cause sternotomy pain are a complex innervation network that includes the T2-T6 dermatomes and is also accompanied by anterior cutaneous nerves of ventral ramus origin [ 4 , 10 , 11 ]. The ESPB is a novel plane block that was defined by Forrero in 2016, demonstrating analgesic activity in thoracic and abdominal surgery.…”

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

“…used both PECS 1 and 2 blocks in their study and found improved outcomes in terms of analgesia and pulmonary function. [ 23 ] However, the control group in this study did not receive any other block. Thus, it's relative efficacy as compared other modes of regional anesthesia is yet to be proven and further studies are required to reconfirm these findings.…”

Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery

“…A 40-patient RCT compared PECS II with no block as part of a postoperative MA strategy in patients undergoing CS with sternotomy. PECS group patients were extubated earlier, had lower pain scores and fewer episodes of rescue analgesia [ 60 ].…”