Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

BACKGROUND: Recent guidelines for perioperative care in cardiac surgery recommend multimodal pain management to decrease opioid use. We evaluated the effect of multimodal pain management including parasternal intercostal nerve block on pain control and opioid use in patients who underwent coronary artery bypass grafting (CABG) requiring sternotomy and cardiopulmonary bypass.
METHODS: Medical records of consecutive patients who underwent CABG from 2018 to 2019 at Huntington Hospital were retrospectively queried. Patients were divided in 2 groups based on whether an Enhanced Recovery After Surgery (ERAS) pain management protocol including parasternal intercostal nerve blocks was employed. Outcomes, including length of stay, pain scores, and opioid use, were compared.
RESULTS: There was no difference in length of stay (days) 5.43 vs. 5.38 (P = .45 and average pain score 2.23 vs. 3.27 (P = .137) for patients in the ERAS and non-ERAS groups. Maximum pain score, 7.74 to 6.15 (P = .015), and opioid use (total morphine mg equivalent), 149.64 to 32.01 (P < .01), were reduced in the ERAS group.
CONCLUSIONS: The ERAS multimodal pain management protocol utilizing intraoperative parasternal blocks appears to reduce pain and decrease opioid use after CABG.

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