Comparison of the Analgesic Efficacy of Chest Wall Blocks in Coronary Artery Bypass Surgery

Ankara City Hospital

Status: Active, not recruiting

Conditions: Postoperative Analgesia; Coronary Arterial Disease (CAD); Transversus Thoracis Muscle Plane Block; Serratus Anterior Muscle Plane Block

Treatments: Procedure: The patient group receiving a combination of deep serratus anterior plane block and transverse thoracic muscle plane block; Procedure: The patient group receiving deep and superficial serratus anterior plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT06657261

AsenaIremYildiz2

Details and patient eligibility

About

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.

Full 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.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 80 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups

The patient group receiving deep and superficial serratus anterior plane block

Active Comparator group

Description:

In this group, the ultrasound probe will be placed on the 5th rib in the mid-axillary line. After visualizing the muscle structures down to the rib (latissimus dorsi, teres major, and serratus anterior), the needle will be advanced using the in-plane technique to two separate areas on the 5th rib: the superficial and deep fascial planes of the serratus anterior muscle. A total of 20 ml of 0.25% bupivacaine will be injected into both areas. The procedure will be performed bilaterally.

Treatment:

Procedure: The patient group receiving deep and superficial serratus anterior plane block

The patient group receiving a combination of deep serratus anterior plane block and transverse thora

Active Comparator group

Description:

In this group, for the TTMP block, the ultrasound probe will be placed on the midclavicular line at the 3rd or 4th intercostal space, where the pleura, pectoralis major, and intercostal muscles will be visualized. A lateral-to-medial scan will be performed to visualize the hypoechoic TTMP located deep to the intercostal muscle and above the pleura. The needle target will be the plane between the internal intercostal muscle and the TTMP. In this area, 10 ml of 0.25% bupivacaine will be injected. The procedure will be performed bilaterally. For the deep SAPB, the ultrasound probe will be placed on the 5th rib in the mid-axillary line. After visualizing the muscle structures down to the rib (latissimus dorsi, teres major, and serratus anterior), the needle will be advanced using the in-plane technique to the fascial plane deep to the serratus anterior muscle on the 5th rib. In this area, 10 ml of 0.25% bupivacaine will be injected. The procedure will be performed bilaterally.

Treatment:

Procedure: The patient group receiving a combination of deep serratus anterior plane block and transverse thoracic muscle plane block