Case
A 75-year-old male with a known history of hypertension, chronic kidney disease IIIb and hyperuricemia underwent aortic valve replacement with a 25-mm bioprosthesis and mitral valve repair with a 30-mm ring via median sternotomy. On the fourth postoperative day, a surgical mediastinal revision due to deep sternal wound infection was needed.
Given the patient’s frailty and the recent cardiac surgery, an awake cardiac operation with subxiphoid access using a Pectoralis-Intercostal Rectus Sheath (PIRS) plane block (Figure 1 A, B) was planned.
In the operating room intraoperative monitoring was provided by ECG, peripheral oxygen saturation, non-invasive blood pressure and end-tidal CO2. The patient was warmed with an active warm touch and received midazolam 2 mg intravenous as preoperative anxiolytic prior to the administration of the ultrasound-guided PIRS.
Once analgesia of the xiphoid region was achieved, surgery was initiated using a subxiphoid access approximately 8 cm long and 6 cm deep (Figure 2).
During the procedure, vital parameters remained stable, and the patient never reported pain. At the end of the procedure, the patient was transferred to the intensive care unit (ICU) with a scheduled infusion of paracetamol (1 g every 8 hours) for 48 hours. No implementation of the analgesic plan was required during the ICU stay and no major effects directly attributable to analgesic technique were observed. On the second postoperative day, the patient was discharged from ICU without any rescue analgesia administration.