Assessment of Pain Control using Ultrasound-guided Bilateral Pecto-intercostal Fascial Plane Block in Pediatric Cardiac Surgeries on Cardiopulmonary Bypass

Objectives: Acute post-operative pain can be a cause of significant morbidity in pediatric cardiac surgical patients. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided bilateral pecto-intercostal fascial plane block (PIFB) in pediatric cardiac surgical patients. Material and Methods: It was a randomized, prospective, single-blinded, comparative study in a tertiary care cardiac center. The study comprised 90 patients with acyanotic and cyanotic congenital heart disease undergoing cardiac surgery through midline sternotomy on cardiopulmonary bypass (CPB), randomized into two groups – Group P (PIFB) and Group C (control). Following surgical skin closure, Group P was administered bilateral PIFB using 3 mg/kg of 0.2% ropivacaine. Fentanyl was provided before extubation, while tramadol was employed post-extubation as rescue analgesia. Paracetamol was administered to both groups as part of a multimodal analgesia protocol. Results: Resting modified objective pain score (MOPS) at 1, 2, 4, 6, 8, 10, 12, 24, and 36 h was measured post-extubation. After exclusions, 83 patients were evaluated. MOPS at all-time intervals for 36 h was comparatively less in the PIFB group ( P < 0.01). Time to extubate ( P < 0.001), post-operative fentanyl pre-extubation ( P < 0.001), time to first rescue analgesia ( P < 0.001), tramadol post-extubation ( P < 0.001), paracetamol requirement ( P < 0.001), intensive care unit length of stay ( P = 0.008), and the hospital length of stay ( P = 0.007) were significantly less in Group P. No adverse events attributable to PIFB were observed. Conclusion: Ultrasound-guided bilateral PIFB represents a safe and effective modality for the management of acute post-operative pain in pediatric patients undergoing cardiac surgery with CPB.