Analgesic Efficacy and Postoperative Outcomes of Serratus Anterior Plane Block in Patients Undergoing Coronary Artery Bypass Grafting via Median Sternotomy Approach

Ahsan Sajjad; Sikandar Hayat; Vaqar Ilahi Paracha; Imtiaz Ahmed Chaudhry; Usama Akhtar; Muhammad Mansoor Tariq

doi:10.70749/ijbr.v3i4.1057

Authors

Ahsan Sajjad Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Punjab, Pakistan.
Sikandar Hayat Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Punjab, Pakistan.
Vaqar Ilahi Paracha Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Punjab, Pakistan.
Imtiaz Ahmed Chaudhry Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Punjab, Pakistan.
Usama Akhtar Department of Cardiac Surgery, Armed Forces Institute of Cardiology, National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Punjab, Pakistan.
Muhammad Mansoor Tariq Department of Cardiac Surgery, Peshawar Institute of Cardiology, Peshawar, KP, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i4.1057

Keywords:

Analgesic Efficacy, Serratus Anterior Plane Block, Post Sternotomy Pain, Artery Bypass Grafting

Abstract

Background: Pain is common at sternotomy site after cardiac surgery. Managing such pain plays an important role in patient recovery. Various side effects are related to the traditional analgesic modalities. To minimize such effects several nerve blocks have been suggested. Objective: The aim of our study is to evaluate the analgesic efficacy of serratus anterior plane block (SAPB) in managing acute post sternotomy pain. Methodology: This randomized control trial included 240 patients between age 18 to 90 undergoing coronary artery bypass grafting (CABG) via median sternotomy approach. The study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Disease Rawalpindi Pakistan, for the duration of five months from October 2024 to February 2025. Patients were divided into two groups: serratus anterior plan block (SAPB) group which received 50mg of 0.25% bupivacaine diluted in 10 ml 0.9% normal saline on both sides and a control group which did not underwent any such intervention. Results: Intra-op fentanyl requirement was lower in SAPB group (221.38 ± 47.11 µg) as compared to control groups (297.22 ± 77.69 µg) (p value <0.001). Post-op tramadol consumption was lower in SAPB group (109.1 ± 21.7 mg) as compared to control groups (201.3 ± 27.4 mg) (p value <0.001). Resting visual analogue score (VAS) was comparable at 6 and 48 hours but at 12 and 24 hours the SAPB group experienced a lower level of pain compared to control group. VAS during coughing was significantly lower in SAPB group as compared to control group at 6, 12 and 24 hours however this became insignificant at 48 hours. Extubation time was shorter in SAPB group than in control group (312±27 vs 377±41) (p value <0.001). Conclusion: SAPB reduces the intra-op dose of anesthetic agent, post-op opioid consumption and pain scores resulting in lower pulmonary complication and early recovery.

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