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It was aimed to examine the effects of anterior chest wall blocks (PECS and SAP) performed for postoperative analgesia on pain scores assessed using the Visual Analog Scale (VAS), opioid consumption, duration of mechanical ventilation, time to first mobilization, ICU length of stay, postoperative nausea and vomiting (PONV), and block-related complications in adult patients undergoing coronary artery bypass grafting (CABG).
This prospective randomized controlled trial evaluated the postoperative analgesic efficacy of ultrasound-guided serratus anterior plane (SAP) block and PECS II block in adult patients undergoing elective coronary artery bypass grafting (CABG). Eligible patients were randomized into three groups: SAP block, PECS II block, and a control group receiving standard systemic analgesia without regional block. The primary outcome was postoperative pain intensity assessed by Visual Analog Scale (VAS) scores at predefined post-extubation time points. Secondary outcomes included total opioid consumption within the first 24 postoperative hours, postoperative nausea and vomiting (PONV), and block-related complications. Exploratory recovery-related outcomes included mechanical ventilation duration, time to first mobilization, and ICU length of stay. Recovery-related outcomes were analyzed descriptively and considered exploratory because ICU clinicians were not blinded and important perioperative confounders were not systematically collected.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| SAP Block Group | Experimental | Patients undergoing coronary artery bypass grafting received an ultrasound-guided serratus anterior plane (SAP) block with 30 mL of 0.25% bupivacaine administered to the fascial plane. |
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| PECS II Block Group | Active Comparator | Patients undergoing coronary artery bypass grafting received an ultrasound-guided PECS II block using a two-injection technique with a total of 30 mL of 0.25% bupivacaine. |
|
| Group C | No Intervention | Patients receiving standard systemic analgesia without regional block. All patients received intravenous paracetamol and rescue opioid analgesia as required according to institutional protocol. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Serratus Anterior Plane Block | Procedure | Ultrasound-guided serratus anterior plane (SAP) block performed with 30 mL of 0.25% bupivacaine. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain intensity assessed using the Visual Analog Scale (VAS) | Pain intensity will be assessed using the Visual Analog Scale (VAS). The VAS is a 10-centimeter scale where 0 cm = "no pain" and 10 cm = "worst imaginable pain"; higher scores indicate worse pain intensity. Assessments will be performed at 4, 8, 12, and 24 hours after extubation. | 4, 8, 12, and 24 hours after extubation |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative nausea and vomiting (PONV) and block-related complications | Postoperative adverse events including nausea, vomiting, and block-related complications will be recorded. | Within 24 hours after surgery |
| Exploratory ICU length of stay |
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Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| School of Mdicine Department of Anesthesiology and Reanimation | Yuzuncu Yil University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Van Yuzuncu Yil University Faculty of Medicine Department of anesthesiology and reanimation | Van | Tuşba | 65080 | Turkey (Türkiye) |
Participants' personal information will not be shared.
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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Prospective randomized controlled trial
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Postoperative outcome assessors were blinded to group allocation.
| PECS II Block | Procedure | Ultrasound-guided PECS II block performed using a two-injection technique with a total of 30 mL of 0.25% bupivacaine. |
|
Length of stay in the intensive care unit measured in hours from ICU admission
| From ICU admission until ICU discharge, assessed up to 30 days |
| Exploratory time to first mobilization | Time from ICU admission to first mobilization measured in hours | From ICU admission until first mobilization, assessed up to 7 days |
| Exploratory mechanical ventilation duration | Time from ICU admission to successful extubation | From ICU admission until successful extubation, assessed up to 7 days |
| Total opioid consumption within the first 24 postoperative hours | Total postoperative opioid consumption will be recorded as cumulative tramadol and pethidine doses administered within the first 24 postoperative hours and converted to intravenous morphine equivalents. | Cumulative opioid consumption assessed during the first 24 postoperative hours |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |