Bali Journal of Anesthesiology · Published 2025-07-01 · DOI 10.4103/bjoa.bjoa_126_25
Background: Effective perioperative pain management in pediatric cardiac surgery remains challenging due to the complex nature of sternotomy pain and chest drain-related discomfort. This study compared the analgesic efficacy and intraoperative hemodynamic effects of ultrasound-guided pre-incisional parasternal intercostal fascial plane block with surgeon-administered post-incisional parasternal block (PSB) in children undergoing congenital heart surgery. Materials and Methods: In this randomized, double-blind controlled trial, 80 children aged 2–12 years with non-cyanotic congenital heart defects undergoing elective open-heart surgery with cardiopulmonary bypass were randomized to receive either PIFP (Group P) or surgeon-administered post-incisional PSB (Group S). The primary outcome was time to first rescue analgesia post-extubation. Secondary outcomes included intraoperative fentanyl consumption, hemodynamic parameters, postoperative pain scores using the modified objective pain score (MOPS), total nalbuphine consumption, and intensive care unit (ICU) length of stay. Results: Eighty children were randomized equally into two groups. Intraoperative fentanyl consumption was significantly lower in Group P (120 [110, 182.5] µg) compared to Group S (175 [164, 210] µg; P < 0.001). Time to first rescue analgesia post-extubation was similar between groups (20 [20–24] vs. 20 [16–24] h, P = 0.125). Postoperative nalbuphine consumption (P = 0.114), MOPS (P > 0.05 across multiple time points), and length of ICU stay (P = 0.32) were also comparable. Conclusions: Pre-incisional ultrasound-guided PSB reduces intraoperative opioid consumption and improves hemodynamic stability without affecting postoperative analgesic outcomes compared to surgeon-administered post-incisional block. Both techniques provide effective analgesia in pediatric cardiac surgery.
Abstract from DOAJ. Public domain (CC0 1.0).
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