CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 156 AFRICA PECS block was more effective in reducing postoperative pain, ventilation support and demand for rescue analgesia.2 The PS block was compared with controls in another study and was found to be more effective in reducing postoperative pain scores and morphine consumption.13 We have conducted the first study with two blocks in two groups after open-heart surgery with sternotomy. We compared the PS block with the PECS II block in terms of age, gender, BMI, block and ventilation duration, postoperative pain scores at rest and cumulative morphine consumption. In our study, the VAS scores at rest were higher in the PECS II block group in the first six hours than in the PS group. It was associated with the block duration, which lasted longer in the PS block group. Cumulative morphine consumption and RASS scores in the PECS II block group were also higher than in the PS block group in the first six hours. There was no difference in ventilation duration between two block groups in our study. There was also no difference in block duration, or pain and sedation scores in the first two hours. The difference in block duration between the groups led to the differences in the fourth and sixth hours in cumulative morphine consumption, sedation and pain scores, which were higher in the PECS II group. In an article by McDonald et al., the PS block was combined with local anaesthetic infiltration after sternotomy. This was associated with early extubation and shorter ventilation duration in the intensive care unit than each alone.7 In our study, we did not determine the length of stay in the intensive care unit. This is one of the limitations of our study. On the other hand, our study is the first comparing the two different blocks that are safe for use in anticoagulated patients after cardiac surgery. Conclusion The PS block provided longer block duration with lower postoperative pain and sedation scores than the PECS II block, as well as lower cumulative morphine consumption. Further studies are required to confirm our findings. References 1. Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth 2011; 25(6): 1163–1178. 2. Kumar KN, Kalyane RN, Singh NG, et al. Efficacy of bilateral pectoralis nerve block for ultrafast tracking and postoperative pain management in cardiac surgery. Ann Cardiac Anaesth 2018; 21(3): 333–338. 3. Bignami E, Castella A, Pota V, et al. Perioperative pain management in cardiac surgery: a systematic review. Minerv Anestesiol 2018; 84(4): 488–503. 4. Nachiyunde B, Lam L. The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review. Ann Cardiac Anaesth 2018; 21(4): 363–370. 5. Caruso TJ, Lawrence K, Tsui BCH. Regional anesthesia for cardiac surgery. Curr Opin Anaesthesiol 2019; 32(5): 674–682. 6. Okitsu K, Iritakenishi T, Iwasaki M, Imada T, Fujino Y. Risk of hematoma in patients with a bleeding risk undergoing cardiovascular surgery with a paravertebral catheter. J Cardiothora Vasc Anesth 2017; 31(2): 453–457. 7. McDonald SB, Jacobsohn E, Kopacz DJ, et al. 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 Analges 2005; 100(1): 25–32. 8. Huang W, Wang W, Xie W, Chen Z, Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J Clin Anesth 2020; 66: 109900. 9. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Revista Espanola Anestesiol Reanim 2012; 59(9): 470–475. 10. Medlej K. Calculated decisions: Richmond agitation–sedation scale (RASS). Emerg Med Prac 2021; 23(Suppl 3): Cd3–cd4. 11. Leong RW, Tan ESJ, Wong SN, Tan KH, Liu CW. Efficacy of erector spinae plane block for analgesia in breast surgery: a systematic review and meta-analysis. Anaesthesia 2021; 76(3): 404–413. 12. Ochroch J, Usman A, Kiefer J, et al. Reducing opioid use in patients undergoing cardiac surgery – preoperative, intraoperative, and critical care strategies. J Cardiothorac Vasc Anesth 2021; 35(7): 2155–2165. 13. Lee CY, Robinson DA, Johnson CA, Jr, et al. A randomized controlled trial of liposomal bupivacaine parasternal intercostal block for sternotomy. Ann Thorac Surg 2019; 107(1): 128–134.
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