Comparison of the Analgesic Efficacy of Chest Wall Blocks in Coronary Artery Bypass Surgery
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Coronary Arterial Disease (CAD)
- Sponsor
- Ankara City Hospital Bilkent
- Enrollment
- 60
- Locations
- 2
- Primary Endpoint
- Comparison of the Analgesic Efficacy of Deep and Superficial Serratus Anterior Plane Block with the Combination of Deep Serratus Anterior Plane and Transverse Thoracic Muscle Plane Block in Coronary Artery Bypass Surgery: A Randomized Controlled Trial
- Status
- Completed
- Last Updated
- last month
Overview
Brief Summary
In this study, the analgesic effects of the Transverse Thoracic Muscle Plane Block and deep Serratus Anterior Plane versus deep and superficial Serratus Anterior Plane applications, which will be performed under ultrasound guidance in patients undergoing coronary artery bypass surgery with sternotomy, will be compared and evaluated.
Detailed Description
Postoperative pain is a critical risk factor for the development of pulmonary and cardiovascular complications in coronary artery bypass graft (CABG) surgery. If effective respiratory function cannot be maintained in patients with high pain levels, atelectasis, cardiac ischemia, and arrhythmias may be observed. This prolongs the hospital discharge time of patients and increases the frequency of postoperative pulmonary complications and postoperative morbidity. Moreover, if postoperative acute pain is not adequately treated, chronic pain may develop after surgery, preventing patients from regaining their normal activities for a long time. In addition to medications, various neuroaxial and peripheral nerve blocks can be used in cardiac surgery. The use of intraoperative heparin limits the application of neuroaxial anesthesia (thoracic epidural and intrathecal opioids) and paravertebral block due to potential complications. Nevertheless, studies have shown their benefits in reducing cardiac and pulmonary complications. Recently, fascial plane nerve blocks, which are alternatives to these methods, have gained more popularity in cardiovascular surgery. These blocks include pectoral nerve blocks, serratus anterior plane block (SAPB), erector spinae plane block (ESPB), transverse thoracic plane blocks (TTMP), pecto-intercostal fascial blocks (PIF), and intercostal nerve blocks. The inability to effectively prevent postoperative pain in cardiac surgery has led not only to the exploration of new block applications but also to the combination of these blocks.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients aged 18-80
- •Patients with ASA score I-II-III
- •Patients with a body mass index (BMI) between 18-35
- •Patients undergoing sternotomy in the operating room
Exclusion Criteria
- •Patients under 18 and over 80 years of age
- •Patients with an ASA score of IV or higher
- •Patients with advanced comorbidities
- •Patients with a history of bleeding diathesis
- •Patients using medications that cause bleeding disorders
- •Patients with infections in the area where the block will be performed
- •Patients with a body mass index (BMI) below 18 or above 35
Outcomes
Primary Outcomes
Comparison of the Analgesic Efficacy of Deep and Superficial Serratus Anterior Plane Block with the Combination of Deep Serratus Anterior Plane and Transverse Thoracic Muscle Plane Block in Coronary Artery Bypass Surgery: A Randomized Controlled Trial
Time Frame: postoperative 24 hours
Postoperative pain intensity will be assessed using the Visual Analog Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher VAS scores indicate worse pain outcomes. Pain scores will be recorded by the pain nurse in the postoperative post-anesthesia care unit (PACU), where patients are routinely monitored for 24 hours. Additional postoperative analgesic consumption and patient satisfaction will also be assessed. For descriptive analysis, pain intensity will be categorized as mild (VAS \<3), mild to moderate (VAS 3-6), and moderate to severe (VAS \>6).