Postoperative outcomes of combined interpectoral–pectoserratus versus combined deep–superficial serratus anterior plane blocks in minimally invasive coronary artery bypass surgery: A prospective randomized study

Minimally invasive coronary artery bypass grafting (MICS-CABG) and minimally invasive direct coronary artery bypass (MIDCAB) reduce surgical trauma compared with sternotomy but remain associated with significant postoperative pain that may delay recovery and contribute to complications. Although regional analgesic techniques are increasingly used to reduce opioid requirements, comparative data on different block strategies are limited. This study evaluated the effects of combined interpectoral–pectoserratus and combined deep–superficial serratus anterior plane blocks on postoperative pain, analgesic consumption, recovery quality, and clinical outcomes. In this prospective randomized single-center clinical study, 180 patients undergoing MICS-CABG or MIDCAB were randomized into three groups: combined interpectoral–pectoserratus plane block (Group P, n = 60), combined deep–superficial serratus anterior plane block (Group S, n = 60), and control (n = 60). All blocks were ultrasound guided and performed by experienced anesthesiologists. Pain intensity was assessed using the visual analog scale (VAS) at 6, 12, 24, and 48 h after extubation. Quality of recovery was evaluated using the QoR-40 questionnaire preoperatively and on postoperative days 1 and 2. Secondary outcomes included time to first rescue analgesia, total analgesic consumption, extubation time, ICU and hospital length of stay, and postoperative complications. VAS scores were significantly lower at all postoperative time points in both block groups compared with the control group, with no difference between block techniques. Time to first rescue analgesia was longer and total postoperative analgesic consumption was lower in both block groups. ICU and hospital stays were significantly shorter in patients receiving combined blocks. QoR-40 scores were better preserved throughout follow-up in both block groups. The incidence of atelectasis was lower in block groups, whereas other postoperative complications were infrequent and did not differ significantly between groups. Combined interpectoral–pectoserratus and combined deep–superficial serratus anterior plane blocks provide effective postoperative analgesia, reduce opioid requirements, enhance early recovery, and shorten ICU and hospital stays after minimally invasive CABG. Both techniques may represent practical opioid-sparing options for perioperative pain management in this setting. This study was also registered with the ISRCTN registry (ISRCTN32677289; first posted 16/02/2026).