Department of Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India.
Department of Plastic Surgery, CARE CIIGMA Hospital, Shahnoorwadi, Aurangabad, Maharashtra, India.
Ann Card Anaesth. 2024 Apr 1;27(2):169-174. doi: 10.4103/aca.aca_107_23. Epub 2024 Apr 12.
Sternal wound complications following sternotomy need a multidisciplinary approach in high-risk postoperative cardiac surgical patients. Poorly controlled pain during surgical management of such wounds increases cardiovascular stress and respiratory complications. Multimodal analgesia including intravenous opioids, non-opioid analgesics, and regional anesthesia techniques, like central neuraxial blocks and fascial plane blocks, have been described. Pecto-intercostal fascial plane block (PIFB), a novel technique, has been effectively used in patients undergoing cardiac surgery. Under ultrasound (US) guidance PIFB is performed with the aim of depositing local anesthetic between two superficial muscles, namely the pectoralis major muscle and the external intercostal muscle. The authors report a series of five cases where US-guided bilateral PIFB was used in patients undergoing sternal wound debridement. Patients had excellent analgesia intraoperatively as well as postoperatively for 24 hours with minimal requirement of supplemental analgesia. None of the patients experienced complications due to PIFB administration. The authors concluded that bilateral PIFB can be effectively used as an adjunct to multimodal analgesia with general anesthesia and as a sole anesthesia technique in selected cases of sternal wound debridement.
胸骨切开术后胸骨伤口并发症需要在高风险心脏手术后患者中采用多学科方法进行处理。在处理此类伤口时，如果疼痛控制不佳，会增加心血管应激和呼吸并发症。已经描述了包括静脉内阿片类药物、非阿片类镇痛药和区域麻醉技术（如中枢神经轴阻滞和筋膜平面阻滞）在内的多模式镇痛。胸肌间筋膜平面阻滞（PIFB）是一种新的技术，已在心脏手术患者中有效使用。在超声（US）引导下，PIFB 是在两块浅层肌肉（胸大肌和肋间外肌）之间注射局部麻醉剂，以达到目的。作者报告了 5 例在接受胸骨伤口清创术的患者中使用超声引导双侧 PIFB 的情况。患者在手术期间以及术后 24 小时内均具有良好的镇痛效果，需要补充镇痛的需求最小。没有患者因 PIFB 给药而出现并发症。作者得出结论，双侧 PIFB 可有效作为全身麻醉下多模式镇痛的辅助手段，并可在胸骨伤口清创术的某些选定病例中作为单一麻醉技术。
