Intraoperative Fascial Plane Blocks Facilitate Earlier Tracheal Extubation and Intensive Care Unit Discharge After Cardiac Surgery: A Retrospective Cohort Analysis

Objectives: Novel fascial plane blocks may allow early tracheal extubation and discharge from the intensive care unit (ICU). The present study primarily aimed to determine whether fascial plane blocks, in comparison with intravenous analgesia alone, significantly shortened tracheal extu-bation times in patients undergoing cardiac surgery. The secondary objectives were to compare each block's performance with that of intrave-nous analgesia alone in terms of the individual tracheal extubation time and length of ICU stay.Design: Retrospective observational study.Setting: Single-center study.Participants: Patients who underwent cardiac surgery between 2018 and 2019 were identified from a prospective clinical registry. After obtain-ing ethics approval, the clinical and electronic records of patients undergoing cardiac surgery in 2018 were analyzed. Data of patients receiving fascial plane blocks (erector spinae plane [ESP], pectoral plane I and II [PECs], and serratus anterior plane [SAP] blocks) with intravenous anal-gesia were compared with those of patients receiving only intravenous analgesia. A propensity score (PS) model was used to control for differen-ces in the baseline characteristics. Adjusted p < 0.05 was considered statistically significant.Measurements and Main Results: Of the 589 patients screened, 532 met the inclusion criteria; 404 received a fascial plane block. After PS matching, weighted linear regression revealed that by receiving a block, the predicted extubation time difference was 9.29 hours (b coefficient; 95% CI:-11.98,-6.60; p = 0.022). Similar results were obtained using PS weighting, with a reduction of 7.82 hours (b coefficient; 95% CI:-11.89,-3.75; p < 0.001) in favor of the block. In the fascial-plane-block group, ESP block achieved the best performance. The length of ICU stay decreased by 1.1 days (b coefficient; 95% CI:-1.43,-0.79; p = 0.0001) in the block group. No complications were reported.Conclusions: Fascial plane block is associated with reduced extubation times and lengths of ICU stay. ESP block achieved the best performance, followed by PECs and SAP blocks. After PS matching, only ESP block reduced the extubation time.(c) 2022 Elsevier Inc. All rights reserved.