Serratus Anterior Plane and PECS II Blocks After Coronary Artery Bypass Grafting
Postoperative Bilateral Serratus Anterior Plane Versus PECS II Block in Intubated Patients Undergoing Elective Coronary Artery Bypass Grafting: A Prospective, Randomized, Placebo-Controlled Trial
Study Overview
Status
Detailed Description
This prospective, randomized, placebo-controlled trial evaluated the postoperative analgesic efficacy of ultrasound-guided bilateral serratus anterior plane (SAP) block and bilateral PECS II block in adult patients undergoing elective coronary artery bypass grafting (CABG). Participants were randomly assigned to one of three groups: bilateral SAP block, bilateral PECS II block, or bilateral sham fascial plane injections (placebo comparator). All participants received the same standardized postoperative systemic analgesic regimen.
To preserve allocation concealment and blinding, an investigator not involved in patient management prepared identical coded syringes according to the randomization sequence. The physician performing the ultrasound-guided procedures was unaware of syringe contents. All participants underwent bilateral injections at both the PECS II and SAP fascial planes; depending on group allocation, each fascial plane received either 0.25% bupivacaine or 0.9% saline. Postoperative outcome assessment was performed by investigators blinded to treatment allocation.
The primary outcome was postoperative pain intensity measured using the Visual Analog Scale (VAS) at predefined time points after extubation. Secondary outcomes included cumulative opioid consumption during the first 24 postoperative hours, postoperative nausea and vomiting (PONV), and block-related complications. Additional recovery-related outcomes included duration of mechanical ventilation, time to first mobilization, and intensive care unit (ICU) length of stay. These recovery outcomes were analyzed as exploratory endpoints because ICU clinicians were not blinded and important perioperative factors influencing recovery were not systematically collected.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Tuşba
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Van, Tuşba, Turkey (Türkiye), 65080
- Van Yuzuncu Yil University Faculty of Medicine Department of anesthesiology and reanimation
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Adults aged 20 years and older ASA physical status II-IV Scheduled for elective coronary artery bypass grafting (CABG) via median sternotomy Extubated in the intensive care unit after surgery Provided written informed consent
Exclusion Criteria:
Refusal to participate or inability to provide informed consent Pregnancy Known allergy or contraindication to bupivacaine or other amide local anesthetics Coagulopathy or ongoing anticoagulation precluding regional anesthesia Local infection at the planned injection site Severe hepatic or renal failure Pre-existing chronic opioid use or chronic pain requiring opioid treatment Pre-existing neurological disorders affecting pain assessment Requirement for emergency surgery or concomitant cardiac procedures other than isolated CABG Reoperation for postoperative bleeding before outcome assessment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: Bilateral SAP Block
Participants undergoing elective coronary artery bypass grafting received an ultrasound-guided bilateral serratus anterior plane (SAP) block using 20 mL of 0.25% bupivacaine on each side.
To maintain study blinding, ultrasound-guided placebo injections consisting of 20 mL of 0.9% saline were also administered bilaterally at the PECS II injection sites using identical coded syringes.
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Ultrasound-guided bilateral serratus anterior plane (SAP) block performed using 20 mL of 0.25% bupivacaine on each side after ICU admission while patients remained intubated following elective coronary artery bypass grafting.
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Active Comparator: Bilateral PECS II Block
Participants undergoing elective coronary artery bypass grafting received an ultrasound-guided bilateral PECS II block using 20 mL of 0.25% bupivacaine on each side.
To maintain study blinding, ultrasound-guided placebo injections consisting of 20 mL of 0.9% saline were also administered bilaterally at the serratus anterior plane injection sites using identical coded syringes.
|
Ultrasound-guided bilateral PECS II block was performed using the standard two-injection technique after ICU admission while patients remained intubated following elective coronary artery bypass grafting.
On each side, a total of 20 mL of 0.25% bupivacaine was injected between the pectoralis major and minor muscles and between the pectoralis minor and serratus anterior muscles.
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Placebo Comparator: Sham Block
Participants undergoing elective coronary artery bypass grafting received ultrasound-guided bilateral placebo injections consisting of 20 mL of 0.9% saline on each side at both the PECS II and serratus anterior plane injection sites using identical coded syringes to maintain study blinding.
All participants received the same standardized postoperative systemic analgesic regimen.
|
Ultrasound-guided bilateral sham fascial plane procedure was performed after ICU admission while patients remained intubated following elective coronary artery bypass grafting.
On each side, 20 mL of 0.9% saline was injected at both the PECS II and serratus anterior plane injection sites using identical coded syringes to maintain study blinding.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Postoperative pain intensity assessed using the Visual Analog Scale (VAS)
Time Frame: 4, 8, 12, and 24 hours after extubation
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Postoperative pain intensity will be assessed using a 10-cm Visual Analog Scale (VAS), where 0 indicates no pain and 10 indicates the worst imaginable pain.
Higher scores indicate greater pain intensity.
Assessments will be performed at 4, 8, 12, and 24 hours after extubation.
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4, 8, 12, and 24 hours after extubation
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Postoperative nausea and vomiting (PONV)
Time Frame: Within 24 hours after surgery
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The occurrence of postoperative nausea and/or vomiting will be recorded during the first 24 hours after surgery.
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Within 24 hours after surgery
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Block-related complications
Time Frame: During hospitalization
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Block-related complications, including local anesthetic systemic toxicity, hematoma, infection, pneumothorax, vascular puncture, nerve injury, or other procedure-related adverse events, will be recorded.
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During hospitalization
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Length of intensive care unit (ICU) stay
Time Frame: From ICU admission to ICU discharge (assessed up to 30 days).
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Length of stay in the intensive care unit (ICU), measured in hours from ICU admission to ICU discharge.
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From ICU admission to ICU discharge (assessed up to 30 days).
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Time to first mobilization
Time Frame: From ICU admission to first mobilization (assessed up to 7 days).
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Time from ICU admission to first mobilization, measured in hours.
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From ICU admission to first mobilization (assessed up to 7 days).
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Duration of mechanical ventilation
Time Frame: From ICU admission to successful extubation (assessed up to 7 days).
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Duration of mechanical ventilation, measured as the time from ICU admission to successful extubation, in hours.
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From ICU admission to successful extubation (assessed up to 7 days).
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Total tramadol and pethidine consumption within the first 24 postoperative hours
Time Frame: Within the first 24 postoperative hours
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Cumulative intravenous tramadol and pethidine doses administered during the first 24 postoperative hours will be recorded and reported separately in milligrams.
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Within the first 24 postoperative hours
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Collaborators and Investigators
Sponsor
Investigators
- Study Chair: School of Mdicine Department of Anesthesiology and Reanimation, Yuzuncu Yil University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 17/05/2023
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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