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TOPLINE:

In adults undergoing coronary artery bypass grafting via median sternotomy with chest drains placed, adding a serratus anterior plane block (SAPB) to a parasternal intercostal plane (PIP) block reduced the postoperative use of opioids and pain at drain sites but did not affect sternotomy pain.

METHODOLOGY:

• Researchers conducted a prospective, randomized controlled study to assess pain and the use of opioids after coronary artery bypass grafting with a PIP block alone vs a PIP block combined with an SAPB.
• They included patients who underwent elective coronary artery bypass grafting via median sternotomy with the placement of two chest drains at a tertiary center in Turkey between September and December 2025. The final analysis included 72 patients.
• Patients were randomly assigned to the PIP group or the PIP+SAPB group. Those in the PIP group received bilateral PIP blocks with 20 mL of 0.25% bupivacaine per side (n = 37; mean age, 65 years; 70.3% men), whereas those in the PIP+SAPB group received bilateral PIP blocks and bilateral deep SAPBs with 10 mL of 0.25% bupivacaine at each of the four injection sites (n = 35; mean age, 63.2 years; 80% men).
• All blocks were performed after induction of general anesthesia under ultrasonographic guidance, with PIP blocks performed at the T4 intercostal level and the deep SAPBs at the T6 level along the midaxillary line. Patients received paracetamol and tramadol for postoperative pain.
• The primary outcome was the total consumption of tramadol during the first 24 hours after extubation, and secondary outcomes included pain scores and recovery measures. The observer assessing these outcomes was blinded to group assignment.

TAKEAWAY:

• Patients in the PIP+SAPB group used less tramadol during the first 24 hours than those in the PIP group (median, 135 mg vs 320 mg), corresponding to a median difference of 150 mg based on the Hodges-Lehmann method (P < .001).
• Pain scores at the drain sites were lower in the PIP+SAPB group at extubation and throughout the first 24 hours (P < .05 for all timepoints). Pain scores at the sternotomy site were similar between the groups at all timepoints.
• Performing the blocks took longer in the PIP+SAPB group than in the PIP group (median, 395 seconds vs 202 seconds; P < .001).
• The time to the first analgesic request, the duration of ventilation, and the time to mobilization did not differ between the groups.

IN PRACTICE:

“Despite a modest increase in block performance time, this approach appears clinically feasible, providing an opioid-sparing effect and improved patient comfort,” the researchers reported. “The results support a component-based regional anesthesia strategy targeting drain-related pain and are consistent with enhanced recovery in cardiac surgery.”

SOURCE:

The study was led by Ekin Güran Aytuğ, MD, of The University of Health Sciences in Ankara, Turkey. It was published online on May 20 in the Journal of Cardiothoracic and Vascular Anesthesia.

LIMITATIONS:

The study was conducted at a single center, limiting external validity of the findings. Researchers did not check sensory spread because blocks were placed under general anesthesia. One anesthesiologist performed all blocks, which may have limited generalizability.

DISCLOSURES:

The authors reported having no relevant financial conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.