Pecto-Intercostal Fascial Block and Inflammatory Mechanism (TNF-Α) in Post-Surgical Heart Pain: a Review Article

Abstract

Background: Postoperative discomfort subsequent to cardiac surgery predominantly originates from sternotomy and heightened inflammatory activation, characterized by elevated concentrations of tumour necrosis factor-α (TNF-α). The pecto-intercostal fascial block (PIFB) technique has emerged as a potent regional analgesic modality for mitigating sternotomy-related pain and is purported to exert a modulatory influence on inflammatory responses. Objective: This literature review aims to explain the relationship between PIFB, inflammatory mechanisms involving TNF-α, and post-cardiac surgery pain. Results: The literature shows that PIFB can reduce post-sternotomy pain intensity, decrease opioid requirements, and accelerate extubation. Although changes in TNF-α levels vary between studies, there is a scientific basis that facial blocks reduce nociceptor activation and may influence inflammatory pathways associated with TNF-α production. This review integrates the latest findings on PIFB and TNF-α and provides a physiological explanation of the potential relationship between the two in the context of post-cardiac surgery pain. Conclusion: PIFB is an effective analgesic technique with the potential to modulate the inflammatory response, although specific evidence regarding changes in TNF-α is still limited and requires further research