Pecto-intercostal Fascial Block Research Articles

Blok Fascial Pecto-intercostal Bilateral sebagai Analgesia untuk Median Sternotomi pada Anak

Median sternotomi pada anak mengakibatkan nyeri akut pascabedah dengan derajat sedang hingga berat, yang berhubungan dengan berbagai efek samping pascabedah. Blok fascia pecto-intercostal yang dipandu ultrasonografi memiliki potensi analgesia untuk median sternotomi sehingga dapat bermanfaat pada populasi anak. Kami melaporkan satu kasus anak laki-laki berusia tiga setengah tahun dengan tumor mediastinum anterior, yang akan menjalani median sternotomi dan eksisi tumor. Pasien dengan status fisik American Society of Anesthesiologists (ASA) 2, fibrosis segmen 2 dan 3 paru kanan dengan riwayat tuberkulosis paru. Eksisi tumor mediastinum anterior melalui median sternotomi berhasil dilakukan dengan fasilitasi kombinasi anestesi umum dan blok fascia pecto-intercostal bilateral. Pemulihan pascabedah juga berjalan dengan lancar. Penggunaan blok fascia pecto-intercostal bersama modalitas lainnya dapat memberikan analgesia yang memadai untuk median sternotomi.
 Kata Kunci: blok fascia pecto-intercostal; sternotomi; manajemen nyeri

Ultrasound-Guided Pecto-Intercostal Fascial Block for Postoperative Pain Management in Cardiac Surgery: A Prospective, Randomized, Placebo-Controlled Trial

To explore the effect of pecto-intercostal fascial plane block (PIFB) on postoperative opioid requirements, pain scores, lengths of intensive care unit and hospital stays and incidence of postoperative delirium in cardiac surgical patients. Single- center, prospective, randomized (1:1), quadruple- blinded, placebo-controlled trial. Single center, tertiary- care center. The study comprised 80 adult cardiac surgical patients (age >18 y) requiring median sternotomy. Patients were randomly assigned to receive ultrasound-guided PIFB, with either 0.25% bupivacaine or placebo, on postoperative days 0 and 1. Of the 80 patients randomized, the mean age was 65.78 ± 8.73 in the bupivacaine group and 65.70 ± 9.86 in the placebo group (p = 0.573). Patients receiving PIFB with 0.25% bupivacaine showed a statistically significant reduction in visual analog scale scores (4.8 ± 2.7 v 5.1 ± 2.6; p < 0.001), but the 48-hour cumulative opioid requirement computed as morphine milligram equivalents was similar (40.8 ± 22.4 mg v 49.1 ± 26.9 mg; p = 0.14). There was no difference in the incidence of postoperative delirium between the groups evaluated using the 3-minute diagnostic Confusion Assessment Method (3/40 [7.5%] v 5/40 [12.5%] placebo; p = 0.45). Patients who received PIFB with bupivacaine showed a decline in cumulative opioid consumption postoperatively, but this difference between the groups was not statistically significant. Low incidence of complications and improvement in visual analog scale pain scores suggested that the PIFB can be performed safely in this population and warrants additional studies with a larger sample size.

Pecto-intercostal Fascial Block for Acute Poststernotomy Pain: A Case Report.

Sternotomy pain is a common complication after cardiac surgery. We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated.

Thoracic interfascial nerve block for breast surgery in a pregnant woman: a case report.

Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.

A Novel Ultrasound-Guided Block: A Promising Alternative for Breast Analgesia

We read with interest “Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation,” by Colque and Eisemann.1 The article prompted us to share with your readers the novel ultrasound-guided anesthetic techniques we use in breast surgery. The intercostal nerve block (ICNB) is traditionally performed using surface anatomical landmarks. Although it is a “blind” technique, ICNB is technically simple to perform, has a high success rate, and has a relatively low overall complication rate. The use of ultrasonography in regional anesthesia allows for visualization of soft tissues and vessels, which in turn improves the accuracy of needle placement.2 We have been performing a relatively new regional anesthetic ultrasound-guided technique in patients who undergo major or minor breast surgery, which has led to decreased systemic perioperative pain, lower analgesic requirements, and improved patient satisfaction.3 In this letter, we introduce 2 new ultrasound-guided techniques. The first is the pecto-intercostal fascial block (PIFB), which consists of injecting a local anesthetic (LA) between the pectoralis major muscle (PMM) and the external intercostal muscle (EIM), in the interfascial plane where the anterior cutaneous branch emerges from the lateral side of the sternal bone. The second technique, known as the serratus intercostal …