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

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

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.

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.

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