Ultrasound-Guided Pecto-Intercostal Block Dramatically Improves Sternotomy Pain and Recovery, Study Finds
Does a simple, targeted nerve block hold the key to better pain control and faster recovery after open heart surgery? For decades, median sternotomy has been the standard approach for cardiac surgery, but it often leaves patients with significant pain and delayed recovery. A new randomized controlled trial offers compelling evidence for a regional anesthesia technique that could change post-sternotomy care.
Background: The Challenge of Post-Sternotomy Pain
Surgical pain following median sternotomy is not just uncomfortable—it can slow extubation, limit mobility, and extend ICU and hospital stays. Traditional high-dose opioids manage pain but come with adverse effects such as respiratory depression, nausea, and risk of chronic pain. There is a growing push for multimodal, opioid-sparing strategies using regional blocks to improve outcomes.
Study Design: Testing the Pecto-Intercostal Fascial Plane Block
Seventy-five adult patients undergoing cardiac surgery by median sternotomy were randomized into three groups:
Group I: No block (control)
Group II: Ultrasound-guided pecto-intercostal fascial plane block (PIFB) with ropivacaine + 25 μg fentanyl per side
Group III: PIFB with ropivacaine + 50 μg fentanyl per side
Pain scores, opioid requirements, extubation times, hemodynamics, time to drain/catheter removal, ambulation, ICU/hospital stay, and complications were tracked for 48 hours post-extubation.
Results: Lower Pain, Less Opioid, Faster Recovery
Pain scores (Numeric Rating Scale) were dramatically lower at every time point in both PIFB groups compared to control, with no significant difference between fentanyl doses.
Cumulative fentanyl consumption was significantly reduced in PIFB groups (Group I: 942 μg, Group II: 672 μg, Group III: 596 μg).
Time to extubation was shortened by over 4 hours with PIFB (Control: 15.8 h, PIFB groups: ~11 h and ~10 h).
Early drain/catheter removal and ambulation occurred in PIFB groups, contributing to shorter ICU and hospital stays.
Incidence of postoperative nausea/vomiting and requirement for rescue analgesia were also lower with PIFB.
No block-related complications (e.g., pneumothorax, vascular injury) were reported.
Clinical Implications: Why This Matters
This study builds on a growing body of evidence supporting ultrasound-guided fascial plane blocks as a safe, effective, and opioid-sparing option in cardiac anesthesia. PIFB is easy to perform, targets pain at its source, and does not compromise hemodynamic stability—key for cardiac patients. The net result: faster extubation, earlier mobilization, and shorter hospital stays.
Conclusion
Preincisional ultrasound-guided PIFB with ropivacaine and fentanyl offers robust post-sternotomy analgesia, promotes earlier recovery milestones, and reduces opioid reliance—all without added risk. As enhanced recovery protocols become standard, this technique may quickly become a cornerstone in cardiac surgical pain management.
Key points
Ultrasound-guided PIFB significantly reduces post-sternotomy pain scores for up to 48 hours.
PIFB decreases opioid consumption and rescue analgesia requirements.
Patients receiving PIFB achieve faster extubation, earlier ambulation, and shorter ICU/hospital stays.
PIFB is safe, with no major block-related complications observed.
No additional benefit was found with higher versus lower fentanyl doses in the block.
Citation:
Malik I, Ahlawat G, Budhwar D, Singh S, Dalai M, Kumar V, Gupta D, Malhotra N. Efficacy of preincisional ultrasound guided pecto-intercostal fascial plane block with ropivacaine and fentanyl in patients undergoing open heart surgery by median sternotomy: A prospective single blinded randomized controlled study. Ann Card Anaesth. 2026;29:335-44. DOI: 10.4103/aca.aca_269_25
