A comparative evaluation of post operative pain between ultrasound guided serratus anterior plane block(SAPB) and erector spinae plane block (ESPB) in patient undergoing minimally invasive cardiac surgery

Enhanced recovery after surgery (ERAS) are being implemented in almost all specialties of surgery, with cardiac surgery being no exception .One of Enhanced recovery after surgery (ERAS) programs the major components of ERAS protocols is pain control using multi-modal commonly faced ""opioid- -sparing’ analgesic regimens. Postoperative pain as a necessary in the postoperative anaesthetia problem and its management is Minimally invasive cardiac surgery has significant advantages compared with care. traditional sternotomy techniques. These include reduced tissue trauma, decreased Despite being less invasive than blood loss, and shorter length of hospital stay 12 traditional sternotomy, these approaches are associated with significant nociceptive inflammatory Pain *, which is traditionally, relied on high-dose opioid-based 2,34 regimens for pain control and the cardio-protective effect of opioids, Ieading to their widespread use. Adverse effects of opioids include respiratory depression, delirium, and gastrointestinal dysfunction, which are particularly problematic in the aging and comorbid population undergoing cardiac surgery. Post thoracotomy pain (PTP) adversely affects the depth of breathing and the ability to cough leading to hypoxemia, atelectasis and other postoperative respiratory impediments to an early recoverys

Nowadays analgesic procedures that reduce opioid consumption and improve postoperative outcomes from minimally invasive cardiac surgery procedures are desirable. The aforementioned elucidation of the importance of ensuring effective post thoracotomy analgesia in conjunction with an early recovery continues to evoke interest in the regional analgesia approach to PTP management. While the intercostal nerve block (ICNB) has been extensively studied and employed for post thoracotomy analgesia, the literature on improved analgesia with fascial plane blocks such as serratus anterior plane block (SAPB) and Erector spine plane block (ESPB) is promising.

We, therefore aim to compare the efficacy of ultrasound guided SAPB with the ESPB block in terms of postoperative pain and cumulative opioid consumption 1N 24 hr post extubation.