Acute Pain Management with Ultrasound-Guided Erector Spinae Plane Block and Serratus Anterior Plane Block in Patients Undergoing Coronary Artery Bypass via Mini-thoracotomy: A Randomized Controlled Trial.

OBJECTIVE

This study was designed to examine the analgesic efficacy of erector spinae plane (ESP) block or combined ESP and superficial serratus anterior plane (SAP) block in patients undergoing elective coronary artery bypass via mini-thoracotomy.

DESIGN

Randomized controlled study.

SETTING

Operating room, intensive care unit, and ward.

PATIENTS: Fifty-four patients undergoing elective coronary artery bypass via mini-thoracotomy.

INTERVENTIONS: Eligible patients were randomly allocated to single-ESP block (ESP group) or combined ESP and superficial SAP block (ESP+SAP group).

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was dynamic numerical rating scale (NRS) scores (on coughing) for the surgical incision site 6 hours after skin closure. Secondary outcomes included dynamic NRS scores for surgical incision at 12, 18, 24, and 48 hours postoperatively plus NRS scores for the chest tube, hydromorphone consumption, quality of recovery, and adverse events within 48 hours postoperatively. The ESP+SAP group had lower dynamic NRS scores for surgical incision at postoperative 6 hours (mean difference: -2.1, 95% CI -2.8 to -1.4, adjusted p < 0.001) and 12 hours (-1.3, 95% CI -2.0 to -0.7, adjusted p < 0.001) compared to the ESP group. The ESP+SAP group also showed lower dynamic NRS scores for the chest tube at 6 hours (-1.4, 95% CI -2.0 to -0.9, adjusted p < 0.001) and 12 hours (-1.2, 95% CI -1.7 to -0.6, adjusted p < 0.001) postoperatively. Linear mixed-model analysis showed that NRS scores for the surgical incision and chest tube were lower in the ESP+SAP group compared to the ESP group (both p < 0.05).

CONCLUSION

Compared with ESP block alone, ESP combined with superficial SAP block reduced pain scores in patients undergoing coronary artery bypass via mini-thoracotomy.