Effects of Serratus Anterior Plane Block (SAP), Pectoral Nerve Blocks (PECS I-II), and Standard Systemic Analgesia on Early Postoperative Recovery After Coronary Artery Bypass Grafting

February 27, 2026 updated by: Arzu Esen Tekeli, Yuzuncu Yil University

A Prospective, Randomized Controlled Trial Comparing Serratus Anterior Plane Block (SAP), Pectoral Nerve Blocks (PECS I-II), and Standard Systemic Analgesia on Mechanical Ventilation Duration and Postoperative Recovery After Coronary Artery Bypass Grafting

The effects of anterior chest wall blocks (PECS and SAP will be used in this study) performed for postoperative analgesia on pain scores (to be checked with visual analogue scale (VAS), opioid consumption, length of hospital stay, mobilization time, side effects and complications in the postoperative period will be examined.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Patients meeting the inclusion criteria and providing written informed consent were randomly assigned to one of three parallel study groups using a computer-generated randomization sequence prepared by an independent investigator.

Participants were allocated in a 1:1:1 ratio to:

Group S (Serratus Anterior Plane Block - SAP):

Following coronary artery bypass grafting (CABG), patients were transferred to the cardiovascular intensive care unit (ICU). Within the first 30 minutes after ICU admission, an ultrasound-guided serratus anterior plane (SAP) block was performed using an 8-cm peripheral block needle. After appropriate aseptic preparation of the anterior chest wall, 30 mL of 0.25% bupivacaine was injected into the fascial plane either superficial or deep to the serratus anterior muscle at the level of the fourth rib. All patients additionally received standardized multimodal systemic analgesia.

Group P (Pectoral Nerve Block - PECS I-II):

After transfer to the ICU, patients received an ultrasound-guided PECS I-II block within the first 30 minutes. Following sterile preparation, 15 mL of 0.25% bupivacaine was injected into the interpectoral plane (between pectoralis major and minor muscles) for PECS I, and an additional 15 mL was injected into the plane between pectoralis minor and serratus anterior muscles for PECS II, totaling 30 mL. Standardized systemic analgesia was also administered.

Group C (Control - Standard Systemic Analgesia):

Patients received standardized multimodal systemic postoperative analgesia without any regional nerve block. Postoperative analgesia included scheduled intravenous paracetamol and rescue opioid administration as needed.

Participants and outcome assessors were blinded to group allocation. The anesthesiologist performing the regional block was not blinded. ICU clinicians responsible for extubation decisions were unaware of treatment allocation.

The study primarily evaluated the duration of mechanical ventilation (time from ICU admission to successful extubation within the first 24 postoperative hours). Secondary outcomes included ICU length of stay, postoperative pain intensity (VAS at 0, 4, 8, 12, and 24 hours post-extubation), total rescue opioid consumption (morphine equivalents), time to first mobilization, postoperative nausea and vomiting (PONV), and length of hospital stay.

Study Type

Interventional

Enrollment (Actual)

243

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • Turkey
      • Van, Turkey, Turkey (Türkiye), 65100
        • Van Yüzüncü Yil University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Agreeing to participate in the study,
  • 20-65 years old
  • ASA I-II-III
  • Open heart surgery

Exclusion Criteria:

  • Refusal to participate in the study
  • 20 years old, over 65 years old
  • Pregnancy
  • Presence of bleeding diathesis
  • Liver or kidney failure
  • Receiving effective treatment on immunity
  • Immune suppressed
  • Those with BMI ≥30

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group S - Serratus Anterior Plane Block
Patients received an ultrasound-guided serratus anterior plane (SAP) block with 30 mL of 0.25% bupivacaine within the first 30 minutes after ICU admission in addition to standardized systemic analgesia.
Procedure: Serratus anterior plane block
Serratus anterior plane block
Experimental: Group P - Pectoral Nerve Block (PECS I-II)
Patients received ultrasound-guided PECS I-II block with a total of 30 mL of 0.25% bupivacaine within the first 30 minutes after ICU admission in addition to standardized systemic analgesia.
Procedure: PECS I-II
PECS I-II
Active Comparator: Group C - Standard Systemic Analgesia
Patients received standardized multimodal systemic analgesia without any regional block. Postoperative analgesia consisted of scheduled intravenous paracetamol and rescue opioid administration as needed.
Other: Standard Systemic Analgesia
Standard postoperative multimodal systemic analgesia without regional nerve block. Postoperative analgesia includes scheduled intravenous paracetamol and rescue opioid administration as needed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Duration of Mechanical Ventilation
Time Frame: Within the first 24 postoperative hours
Time (in hours) from ICU admission to successful extubation.
Within the first 24 postoperative hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of Intensive Care Unit (ICU) Stay
Time Frame: Assessed once at the time of ICU discharge, measured as total hours from ICU admission to ICU discharge (expected within 30 postoperative days).
Total duration of ICU stay measured in hours from ICU admission to ICU discharge.
Assessed once at the time of ICU discharge, measured as total hours from ICU admission to ICU discharge (expected within 30 postoperative days).
Postoperative Pain Intensity at Rest (VAS)
Time Frame: Assessed at 0, 4, 8, 12, and 24 hours after extubation within the first 24 hours post-extubation.
Pain intensity measured using the Visual Analog Scale (VAS; 0-10 cm, 0=no pain and 10=worst imaginable pain). Assessments performed after extubation when adequate consciousness was confirmed.
Assessed at 0, 4, 8, 12, and 24 hours after extubation within the first 24 hours post-extubation.
Total Rescue Opioid Consumption (Morphine Equivalents)
Time Frame: Within the first 24 hours after extubation
Total rescue analgesic requirement within 24 hours, calculated by converting administered tramadol and pethidine doses to intravenous morphine equivalents using predefined equianalgesic ratios.
Within the first 24 hours after extubation
Time to First Mobilization
Time Frame: Assessed once when first active sitting at bedside is achieved, within 48 hours after ICU admission.
Time (in hours) from ICU admission to the first active sitting at the bedside with assistance under ICU staff supervision.
Assessed once when first active sitting at bedside is achieved, within 48 hours after ICU admission.
Postoperative Nausea and Vomiting (PONV)
Time Frame: Assessed at 0-24, 24-48, and 48-72 hours after extubation during postoperative ICU and ward follow-up.
Presence of nausea and/or vomiting recorded as a binary outcome (present/absent) during routine assessments and on patient report.
Assessed at 0-24, 24-48, and 48-72 hours after extubation during postoperative ICU and ward follow-up.
Length of Hospital Stay
Time Frame: Assessed once at hospital discharge, measured as total days from date of surgery to hospital discharge (expected within 30 postoperative days).
Total duration of hospital stay measured in days from the day of surgery to hospital discharge.
Assessed once at hospital discharge, measured as total days from date of surgery to hospital discharge (expected within 30 postoperative days).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Yuzuncu Yil University

Investigators

  • Study Chair: School of Medicine Department of Anesthesiology and Reanimation, Yuzuncu Yil University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 15, 2023

Primary Completion (Actual)

April 26, 2024

Study Completion (Actual)

November 1, 2024

Study Registration Dates

First Submitted

May 23, 2023

First Submitted That Met QC Criteria

July 22, 2023

First Posted (Actual)

July 25, 2023

Study Record Updates

Last Update Posted (Actual)

March 3, 2026

Last Update Submitted That Met QC Criteria

February 27, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 22.05.2023-1

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

participiants's personal information will not be shared anyone

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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