Evaluation of Serratus Anterior Plane Block for Pain Relief in Patients Undergoing MIDCAB Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with severe chest pain in the first 2 to 3 postoperative days; this may delay the patient recovery. In this randomized controlled trial we evaluated the role of serratus anterior plane (SAP) block for postoperative pain relief in patients undergoing MIDCAB surgery. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Patients undergoing MIDCAB surgery were randomized into 2 groups of 25 each; SAP group received 20 mL of 0.2% ropivacaine with 1 μg/mL fentanyl as bolus followed by infusion at 8 mL/h; control group received saline for both bolus and infusion. Primary outcome measure was postoperative pain when supine, and during deep inspiration, coughing, and patient movement; secondary outcome measures were requirement of postoperative intravenous fentanyl and opioid-related side effects. All patients were followed at 6-hourly intervals for 48 hours in the postoperative period. Results were analyzed by the Student’s t -test, χ <jats:sup>2</jats:sup> test, Mann–Whitney U-test and Kruskall–Wallis test. A P-value &lt;0.05 was considered significant. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The 2 groups were similar with respect to patient characteristics. Static and dynamic pain visual analog scale scores were significantly reduced in the SAP group as compared to the control group at most of the time points of assessment ( P &lt; 0.05). Patient-controlled fentanyl requirements were reduced in the SAP group as compared to control group on the second postoperative day ( P &lt; 0.05). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> SAP block reduced the postoperative pain scores and opioid requirements in patients undergoing MIDCAB surgery. </jats:p></jats:sec>

Serratus Anterior Plane Block—A Promising Technique for Regional Anesthesia in Minimally Invasive Cardiac Surgery

“…10 The results of SAPB may at times be conflicting. [11][12] In a randomized trial (N = 50: single institution) evaluating SAPB for analgesia after minimally invasive direct coronary artery bypass, Gautam et al reported significantly reduced postoperative pain scores and opioid requirements in the setting of SAPB. 11 In this trial, the control group received no regional analgesic block and systemic analgesia with titrated opioid, including fentanyl.…”

“…[11][12] In a randomized trial (N = 50: single institution) evaluating SAPB for analgesia after minimally invasive direct coronary artery bypass, Gautam et al reported significantly reduced postoperative pain scores and opioid requirements in the setting of SAPB. 11 In this trial, the control group received no regional analgesic block and systemic analgesia with titrated opioid, including fentanyl. 11 In a retrospective observational trial (N = 197), Moll et al evaluated analgesic options (SAPB v paravertebral block v titrated systemic opioid) after minimally invasive direct coronary artery bypass at a single institution.…”

“…11 In this trial, the control group received no regional analgesic block and systemic analgesia with titrated opioid, including fentanyl. 11 In a retrospective observational trial (N = 197), Moll et al evaluated analgesic options (SAPB v paravertebral block v titrated systemic opioid) after minimally invasive direct coronary artery bypass at a single institution. 12 After multiple variable regression analyses, SAPB did not significantly reduce opioid consumption compared with no regional block (p = 0.15) and was associated with significantly higher opioid rescue compared with paravertebral block (p = 0.049 for continuous SAPB and p = 0.049 for single shot SAPB).…”

“…12 The conflicting results of these trials are likely explained by differences in trial design and conduct, including the selection criteria for control groups. [11][12] Further prospective clinical trials are required, with adequate power and clearly designated control groups, to evaluate the efficacy of SAPB in contemporary cardiothoracic practice to overcome trial limitations and confounders due to factors such as retrospective design and small sample size. [13][14][15][16][17] The current confounders across the trials of SAPB for analgesia after cardiac surgery can be considered with respect to the control group or the interventional group.…”

“…[13][14][15][16][17] The current confounders across the trials of SAPB for analgesia after cardiac surgery can be considered with respect to the control group or the interventional group. [5][6][7][8][9][10][11][12] The control group has typically received institution-specific titrated systemic analgesia, including opioids. This systemic analgesic approach has at times not only been multimodal but has been combined with a regional block other then SAPB, including alternative fascial plane blocks.…”