ReviewJournal of pain research2026
Parasternal Intercostal Plane Blocks for Enhanced Recovery After Cardiac Surgery: A Systematic Review of Technical Refinements and Evidentiary Support.
Review in Journal of pain research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
3 authors.
Funding
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Abstract
Background: Parasternal intercostal plane (PIP) blocks provide opioid-sparing analgesia within cardiac Enhanced Recovery After Surgery (ERAS) pathways, but non-standardized nomenclature and ambiguous anatomical targets limit their adoption. Methods: A systematic search of PubMed, Cochrane, and Embase databases was conducted. Inclusion criteria encompassed randomized controlled trials and observational studies reporting on PIP blocks in adult cardiac surgery to synthesize evidence on their efficacy, technical refinements, and safety. Results: This review integrated 20 clinical studies (2019-2025). Adopting the El-Boghdadly terminology resolves descriptive inconsistencies by distinguishing superficial (SPIP) and deep (DPIP) techniques. SPIP targets the pectoralis major-intercostal interface (T2-T6), while DPIP accesses the intercostal-transversus thoracis plane (T1-T6). PIP blocks reduced 12-hour postoperative pain (average 1.21-point reduction) and opioid use (average 30.34 milligram morphine equivalents (MME) reduction), though analgesic benefits diminished after 24 hours. SPIP provides a safer profile with minimal internal mammary artery (IMA) injury risk but limited cephalad spread. DPIP achieves broader dermatomal coverage but positions the needle 3-5 mm from the IMA; thus, it should be applied with caution or replaced by SPIP in post-CABG patients. Recovery outcomes demonstrated earlier extubation and shorter intensive care unit stays. However, bupivacaine concentrations approached neurotoxic thresholds ≥2.0 μg/mL in 7.1% of DPIP cases. Conclusion: PIP blocks provide effective opioid-sparing analgesia, requiring meticulous anatomical execution. SPIP is favored for safety, whereas DPIP demands real-time ultrasound guidance and caution in patients with IMA grafts. Future research should optimize dermatomal coverage, refine individualized dosing, and evaluate long-term outcomes.
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