Journal Article

The analgesic effects of combined bilateral parasternal block and serratus anterior plane block for coronary artery bypass grafting surgery

Çobas, Muhammed, Aslı Demir, Zeliha, Salman, Nevriye, Yiğit, Hülya, Zengin, Emine Nilgün

2024

Overview

Background Severe pain occurs after cardiac surgery in the sternum and chest tubes sites. Although analgesia targeting the sternum is often prioritized, the analgesia of the drain site is sometimes overlooked. This study of patients undergoing coronary artery bypass grafting (CABG) aimed to provide optimized analgesia for both the sternum and the chest tubes area by combining parasternal block (PSB) and serratus anterior plane block (SAPB). Methods Ethics committee approval (E.Kurul-E2-24-6176, 07/02/2024) was received for the study. Then, the trial was registered on www.clinicaltrials.gov ( https://clinicaltrials.gov/ ) under the identifier NCT05427955 on 17/03/2024. Twenty patients between the ages of 18–80, with ASA physical status classification II-III, undergoing coronary artery bypass grafting CABG with sternotomy, were included. While the patients were under general anesthesia, PSB was performed through the second and fourth intercostal spaces, and SAPB was performed over the sixth rib. The primary outcome was VAS (Visual Analog Scale) during the first 12 h after extubation. The secondary outcomes were intraoperative remifentanil consumption and block-related side effects. Results The average age of the patients was 64 years. Five patients were female, and 15 were male. For the sternum area, only one patient had resting VAS scores of 4, while the VAS scores for resting for the other patients were below 4. For chest tubes area, only two patients had resting VAS scores of 4 or above, while the resting VAS scores for the other patients were below 4. The patients’ intraoperative remifentanil consumption averaged 2.05 mg. No side effects related to analgesic protocol were observed in any of the patients. Conclusions In this preliminary study where PSB and SAPB were combined in patients undergoing CABG, effective analgesia was achieved for the sternum and chest tubes area.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acute pain / Adult / Aged / Aged, 80 and over / Analgesia / Analgesics / Analgesics, Opioid - administration & dosage / Analysis / Anesthesia / Anesthesiology / Anticoagulants / Body mass index / Bupivacaine / Bypass / Cardiac patients / Cardiac surgery / Chest / Chest tube site pain / Chest tubes / Coronary artery / Coronary artery bypass / Coronary Artery Bypass - methods / Coronary vessels / Critical Care Medicine / Delirium / Drain pain / Emergency Medicine / Epidural / Extubation / Female / General anesthesia / Heart surgery / Humans / Intensive / Internal Medicine / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Nerve Block - methods / Pain / Pain Measurement - methods / Pain perception / Pain, Postoperative - drug therapy / Pain, Postoperative - prevention & control / Parasternal block / Patients / Postoperative period / Remifentanil / Remifentanil - administration & dosage / Serratus anterior plane block / Side effects / Sternum / Sternum - surgery / Surgery / Surgical apparatus & instruments / Ultrasonic imaging / Veins & arteries / Young Adult