Pecto-Intercostal Fascial Plane Block Catheter Trial for Reduction of Sternal Pain

Summary

One of the most painful aspects of open heart surgery is the incision made through the skin and the sternum to access the heart (a "sternotomy"). Post-sternotomy pain is a potentially debilitating complication of surgery that slows recovery immediately after surgery and can lead to issues with chronic pain. Previous research has shown that by injecting local anesthesia in the pecto inter-fascial plane, the space between the pectoralis major and the intercostal muscles, pain relief can be provided. The investigators aim to assess if repeated injections of local anesthesia via catheters is a useful adjunct compared to routine care.

Timeline

Start

2022-09-07

Primary completion

2024-01

Completion

2024-07

Publications

• Background Liu V, Mariano ER, Prabhakar C. Pecto-intercostal Fascial Block for Acute Poststernotomy Pain: A Case Report. A A Pract. 2018 Jun 15;10(12):319-322. doi: 10.1213/XAA.0000000000000697.
• Background Lee W, Yan YY, Jensen MP, Shun SC, Lin YK, Tsai TP, Lai YH. Predictors and patterns of chronic pain three months after cardiac surgery in Taiwan. Pain Med. 2010 Dec;11(12):1849-58. doi: 10.1111/j.1526-4637.2010.00976.x. Epub 2010 Oct 28.
• Background van Gulik L, Janssen LI, Ahlers SJ, Bruins P, Driessen AH, van Boven WJ, van Dongen EP, Knibbe CA. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011 Dec;40(6):1309-13. doi: 10.1016/j.ejcts.2011.03.039. Epub 2011 May 10.
• Background Gust R, Pecher S, Gust A, Hoffmann V, Bohrer H, Martin E. Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Crit Care Med. 1999 Oct;27(10):2218-23. doi: 10.1097/00003246-199910000-00025.
• Background Sasseron AB, Figueiredo LC, Trova K, Cardoso AL, Lima NM, Olmos SC, Petrucci O. Does the pain disturb the respiratory function after open heart surgery? Rev Bras Cir Cardiovasc. 2009 Oct-Dec;24(4):490-6. doi: 10.1590/s0102-76382009000500010. English, Portuguese.
• Background Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chiolero R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000 Aug;118(2):391-6. doi: 10.1378/chest.118.2.391.
• Background Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006 Oct;105(4):794-800. doi: 10.1097/00000542-200610000-00026.
• Background Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestfeld S, Beckman D. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004 Mar;13(2):116-25.
• Background Mittnacht AJC, Shariat A, Weiner MM, Malhotra A, Miller MA, Mahajan A, Bhatt HV. Regional Techniques for Cardiac and Cardiac-Related Procedures. J Cardiothorac Vasc Anesth. 2019 Feb;33(2):532-546. doi: 10.1053/j.jvca.2018.09.017. Epub 2018 Sep 13. No abstract available.
• Background Hemmerling TM, Cyr S, Terrasini N. Epidural catheterization in cardiac surgery: the 2012 risk assessment. Ann Card Anaesth. 2013 Jul-Sep;16(3):169-77. doi: 10.4103/0971-9784.114237.
• Background Fujii S, Bairagi R, Roche M, Zhou JR. Transversus Thoracis Muscle Plane Block. Biomed Res Int. 2019 Jul 7;2019:1716365. doi: 10.1155/2019/1716365. eCollection 2019.
• Background Fujii S, Roche M, Jones PM, Vissa D, Bainbridge D, Zhou JR. Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study. Reg Anesth Pain Med. 2019 May;44(5):556-560. doi: 10.1136/rapm-2018-100178. Epub 2019 Mar 21.
• Background Chin KJ. An Anatomical Basis for Naming Plane Blocks of the Anteromedial Chest Wall. Reg Anesth Pain Med. 2017 May/Jun;42(3):414-415. doi: 10.1097/AAP.0000000000000575. No abstract available.
• Background Murata H, Hida K, Hara T. Reply to Dr Del Buono et al. Reg Anesth Pain Med. 2016 Nov/Dec;41(6):792. doi: 10.1097/AAP.0000000000000491. No abstract available.
• Background Fujii S, Vissa D, Ganapathy S, Johnson M, Zhou J. Transversus Thoracic Muscle Plane Block on a Cadaver With History of Coronary Artery Bypass Grafting. Reg Anesth Pain Med. 2017 Jul/Aug;42(4):535-537. doi: 10.1097/AAP.0000000000000607. No abstract available.
• Background Garcia Simon D, Fajardo Perez M. Safer alternatives to transversus thoracis muscle plane block. Reg Anesth Pain Med. 2019 Jul 11:rapm-2019-100666. doi: 10.1136/rapm-2019-100666. Online ahead of print. No abstract available.
• Background Fujii S. Transversus thoracis muscle plane block and alternative techniques. Reg Anesth Pain Med. 2019 Jul 11:rapm-2019-100755. doi: 10.1136/rapm-2019-100755. Online ahead of print. No abstract available.
• Background Ueshima H, Otake H. RETRACTED: Optimal site for the subpectoral interfascial plane block. J Clin Anesth. 2017 Feb;37:115. doi: 10.1016/j.jclinane.2016.12.022. Epub 2017 Jan 9. No abstract available.
• Background McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, Hall RA. Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesth Analg. 2005 Jan;100(1):25-32. doi: 10.1213/01.ANE.0000139652.84897.BD.
• Background Gianchandani RY, Saberi S, Zrull CA, Patil PV, Jha L, Kling-Colson SC, Gandia KG, DuBois EC, Plunkett CD, Bodnar TW, Pop-Busui R. Evaluation of hemoglobin A1c criteria to assess preoperative diabetes risk in cardiac surgery patients. Diabetes Technol Ther. 2011 Dec;13(12):1249-54. doi: 10.1089/dia.2011.0074. Epub 2011 Aug 21.
• Background Jokinen MJ, Neuvonen PJ, Lindgren L, Hockerstedt K, Sjovall J, Breuer O, Askemark Y, Ahonen J, Olkkola KT. Pharmacokinetics of ropivacaine in patients with chronic end-stage liver disease. Anesthesiology. 2007 Jan;106(1):43-55. doi: 10.1097/00000542-200701000-00011.
• Background Christensen MC, Dziewior F, Kempel A, von Heymann C. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth. 2012 Feb;26(1):46-51. doi: 10.1053/j.jvca.2011.09.021. Epub 2011 Nov 18.
• Background Bernstein SL, Bijur PE, Gallagher EJ. Relationship between intensity and relief in patients with acute severe pain. Am J Emerg Med. 2006 Mar;24(2):162-6. doi: 10.1016/j.ajem.2005.08.007.
• Background Zubrzycki M, Liebold A, Skrabal C, Reinelt H, Ziegler M, Perdas E, Zubrzycka M. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res. 2018 Aug 24;11:1599-1611. doi: 10.2147/JPR.S162067. eCollection 2018.
• Jen TTH, Prabhakar C, Matras PJ, Rondi K, Bruce S, Sun T, Edwards NY, Mehta S, Schwarz SKW, Chau A, Ree RM. Analgesic efficacy of continuous superficial parasternal intercostal plane blockade in patients undergoing cardiac surgery with median sternotomy: a randomized controlled trial. Reg Anesth Pain Med. 2025 Nov 26:rapm-2025-107162. doi: 10.1136/rapm-2025-107162. Online ahead of print.

Drugs

Indications

No indication recorded.