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)