Does using a nerve block help reduce chronic pain after off-pump coronary artery bypass grafting?
Chronic postsurgical pain (CPSP) is common after off-pump coronary artery bypass grafting (OPCABG), affecting about 1 in 3 patients. A nerve block called pectoral-intercostal fascial block (PIFB) with ropivacaine has been studied to see if it can prevent this pain. The short answer: PIFB did not lower the overall rate of chronic pain at 3 months, but it did reduce acute pain right after surgery and cut down on moderate-to-severe chronic pain.
What the research says
A 2026 randomized trial of 260 elderly patients undergoing OPCABG tested PIFB with ropivacaine against placebo 16. The overall rate of chronic pain at 3 months was 34.6% 16. PIFB did not significantly reduce the overall incidence of CPSP (30.2% vs 38.8% with placebo, p=0.143) 16. However, it did reduce acute pain on the first day after surgery and lowered the rate of moderate-to-severe chronic pain 16. The same trial also found that another intervention, transcutaneous auricular vagus nerve stimulation (taVNS), did reduce overall CPSP 16. There was no interaction between the two treatments, meaning they worked independently 16. Risk factors for chronic pain included preoperative anxiety, pain catastrophizing, acute postoperative pain, and high levels of the inflammatory marker IL-6 16. Another study protocol suggests that newer nerve blocks like the intertransverse process block might also help, but results are not yet available 7.
What to ask your doctor
- Would a pectoral-intercostal fascial block (PIFB) be appropriate for my surgery to help with acute pain?
- What are the risks and benefits of nerve blocks compared to standard pain management after off-pump CABG?
- Could transcutaneous auricular vagus nerve stimulation (taVNS) be an option for me to reduce chronic pain?
- How can I manage preoperative anxiety and pain catastrophizing, which are risk factors for chronic pain?
- What other multimodal pain management strategies are available at this center?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.