{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:46:32Z","timestamp":1791985592252,"version":"4.4.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ultrasound-guided facial plane blocks are central to enhanced recovery after cardiac surgery (ERACS) protocols, yet evidence comparing pecto-intercostal facial plane block (PIFB) and transversus thoracic facial plane block (TTPB) with rectus sheath block (RSB) remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective, randomized, controlled trial enrolled 100 adult patients (ASA II\u2013III) undergoing elective median sternotomy at a tertiary care hospital in South India. Patients received standardized general anesthesia and were randomized to bilateral PIFB or TTPB (20 mL 0.25% bupivacaine + 4 mg dexamethasone per side) with RSB after cardiopulmonary bypass. The primary outcome was 24-hour postoperative fentanyl consumption. Secondary outcomes included visual analog scale (VAS) pain scores at 0, 3-, 6-, 12-, and 24-hours post-extubation, rescue analgesia, extubation timing, ICU\/hospital stay, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 96 patients completed analysis (PIFB:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 47; TTPB:\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 49). Mean 24-hour fentanyl consumption was 267.23 \u00b1 92.54 \u00b5g (PIFB) vs 297.18 \u00b1 88.09 \u00b5g (TTPB), mean difference \u2212 29.95 \u00b5g (95% confidence interval: \u221266.60 to 6.70;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.108). VAS scores showed no significant between-group differences (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). Rescue analgesia rates were similar, with 84% and 90% not requiring additional opioids. Four PIFB patients (8%) stayed intubated &gt;24 hours due to cardiac issues, vs none in the TTPB group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.121).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This trial found no significant difference in opioid consumption or pain scores between PIFB + RSB and TTPB + RSB for post-sternotomy analgesia. Both techniques were safe within ERACS protocols. Larger noninferiority trials are needed before establishing equivalence or recommending one technique over another.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_112_26","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:00:06Z","timestamp":1791824406000},"page":"577-586","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Efficacy of Pecto-Intercostal Facial Plane Block vs Transversus Thoracic Facial Plane Block Combined with Rectus Sheath Block for Post-Sternotomy Analgesia: A Prospective Randomized Controlled Trial"],"prefix":"10.4103","volume":"29","author":[{"given":"Priya","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravikanth","family":"Pula","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venu","family":"Polapally","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunanda","family":"Gooty","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varsha","family":"Krosuri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagarjuna","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramachandran","family":"Gopinath","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, ESIC Medical College and Super Speciality Hospital, Sanathnagar, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"R1-20261014","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.crad.2023.10.023","article-title":"A radiologist's guide to median sternotomy","volume":"79","author":"Young","year":"2024","journal-title":"Clin Radiol"},{"key":"R2-20261014","doi-asserted-by":"crossref","first-page":"3729","DOI":"10.1111\/jocs.16882","article-title":"Median sternotomy pain after cardiac surgery: To block, or not? 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