The effect of ultrasound-guided bilateral pecto-intercostalfascial plane block on analgesia after pediatric open cardiac surgery: A case series

Pain following cardiac surgery may be related to sternotomy incision, intraoperative tissue dissection, vascular cannulation, or chest tube insertion. The evolution of ultrasound-guided regional analgesic modalities has resulted in the widespread application of regional techniques for postoperative analgesia in the pediatric population. Hence, we propose to assess the analgesic efficacy of ultrasound-guided Pecto-Intercostal fascial plane block (PIFB) in children undergoing open-heart surgery through a median sternotomy approach. A series of 15 patients aged group 1-7 years undergoing elective congenital cardiac surgery requiring median sternotomy were included in the study. After correct identification of the Pecto-Intercostal fascial plane, saline hydrodissection was performed to confirm the plane, followed by the administration of bupivacaine 2.5 mg/kg (0.25%) and Fentanyl 1 mcg/kg under visualization. A total volume of 1 ml/kg was used, which was distributed equally between both Pecto-Intercostal fascial planes (0.5 ml/kg on each side). The primary outcome measure were intraoperative fentanyl consumption and assessment of pain scores in the first 24 hours post-extubation. The secondary outcome measures were additional fentanyl consumption in the postoperative period and the time to extubation. The total intraoperative fentanyl requirements and fentanyl consumption in the first 24 hours post-extubation were significantly lower in our study population. FLACC scale were lower up to 6 hours post-extubation, but no change in time to extubation was noted. Bilateral ultrasound-guided PIFB is effective in providing postoperative analgesia in children undergoing open-heart surgery via median sternotomy incision.