The Impact of Preoperative Combined Pectoserratus and/or Interpectoral Plane (Pectoralis Type II) Blocks on Opioid Consumption, Pain, and Overall Benefit of Analgesia in Patients Undergoing Minimally Invasive Cardiac Surgery: A Prospective, Randomized, Controlled, and Triple-blinded Trial

Abstract

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 aimed to assess the influence of combined pectoserratus-plane-block plus interpectoral-plane-block (PSPB+IPPB) on postoperative pain and overall benefit of analgesia compared to placebo. DesignProspective, randomized, triple-blinded. SettingThe operating room, intensive care unit of a university hospital Participants60 patients undergoing elective right-lateral MICS. InterventionsPatients were randomly assigned to preoperative PSPB+IPPB with 30 ml 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 (24 h - ivMME). Secondary endpoints included the Overall Benefit of Analgesia Score (OBAS) at 24h after extubation and repeated visual analogue scale (VAS). 24 hours - ivMMEs were significantly lower (median (IQR): 4.2 mg (2.1 – 7.9) versus 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) versus 7.0 (3.0 – 9.0), p = 0.043; 0.0 cm (0.0 - 2.0) versus 1.5 cm (0.3 - 3.0); p = 0.030). VAS did not differ between groups at later points. ConclusionsPre-operative PSPB+IPPB reduced 24 hours post-extubation 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.