PIRS- technique
With the patient in supine position, a linear ultrasound probe was positioned 2-3 cm from midline slightly cephalad to the umbilicus to perform the Rectus Sheath block (RSB). A 22-gauge 50 mm SonoPlex Stim needle (Pajunk Medical System) was then inserted in plane and in lateral-medial direction, targeting the space between the rectus abdominis muscle and the posterior sheath. After the position of the needle tip was confirmed, 20 ml of Ropivacaine 0,375% was administered and the same procedure was performed on the other side (Fig 1 A).
Then the linear probe was placed on the chest in a parasagittal plane over the sixth rib at the midclavicular line lateral to xiphoid process, in order to perform bilateral Pectointercostal fascial plane block (PIFB) and provide analgesia of the anterior cutaneous branches of T4-T6 intercostal nerves. A 22-gauge, 50 mm Sonoplex Stim needle (Pajunk Medical System, Tucker GA) was advanced via an in-plane approach from the cranial to caudal direction until it reached the interfascial plane between Pectoralis Major muscle and External Intercostal muscle. After the position of the needle tip was confirmed, 10 ml of Ropivacaine 0,75% was administered; the same procedure was performed on the other side. (Fig. 1 B)