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Background <p>Although minimally invasive cardiac surgery (MICS) is less invasive, patients may still experience significant postoperative pain. This observational study aimed to evaluate the feasibility and postoperative analgesic profile associated with the combined serratus anterior plane block (CSAPB), a component of multimodal analgesia in patients undergoing MICS.</p> Methods <p>Twenty patients, aged 18 to 80, who underwent MICS and provided written informed consent, were included in the study. Standard cardiac anesthesia monitoring was performed. Ultrasound-guided CSAPB was performed preemptively after induction of general anesthesia as part of a multimodal analgesia strategy, using a total of 40 mL of 0.25% bupivacaine, with 20 mL administered into each of the deep and superficial serratus anterior planes. All patients received intravenous acetaminophen 1&#xa0;g and tramadol 1&#xa0;mg·kg<sup>− 1</sup> at the end of surgery. Within the first 24&#xa0;h, patients received 1 gram of acetaminophen every 6&#xa0;h. Visual Analog Scale (VAS) scores were recorded at 0, 2, 4, 8, and 12&#xa0;h after extubation. If the VAS score exceeded 40&#xa0;mm at any point, the initial treatment was tramadol at a dosage of 1&#xa0;mg·kg<sup>− 1</sup>. If pain continued, 0.5&#xa0;mg·kg<sup>− 1</sup> morphine was planned.</p> Results <p>The hemodynamic parameters remained within clinically acceptable ranges. In 2 patients (10%), VAS scores exceeded 40&#xa0;mm, requiring rescue analgesia. A statistically significant difference was observed in terms of changes in rest VAS scores (<i>p</i> = 0.015). Significant differences were also observed in the changes in cough VAS scores over time (<i>p</i> = 0.003). Nausea and vomiting were observed in 2 patients (10%). No other complications were observed during the follow-up period.</p> Conclusions <p>Multimodal analgesia, including CSAPB, appears to be a feasible regional analgesia technique associated with low postoperative pain scores and minimal rescue analgesic requirements in patients undergoing MICS via right mini-thoracotomy.</p> Trial registration <p>Clinicaltrials Registration No: NCT06326320, Registration Date: 17/03/2024.</p>

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Feasibility and postoperative analgesic profile of multimodal analgesia including combined serratus anterior plane block in minimally invasive cardiac surgery: a prospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月30日

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  • Emine Nilgün Zengin,
  • Aslıhan Aykut,
  • Ayşegül Özgök,
  • Musa Zengin,
  • Onur Küçük,
  • Asena İrem Yıldız,
  • Fatih Üngör,
  • Ali Alagöz,
  • Nevriye Salman,
  • Zeliha Aslı Demir

摘要

Background

Although minimally invasive cardiac surgery (MICS) is less invasive, patients may still experience significant postoperative pain. This observational study aimed to evaluate the feasibility and postoperative analgesic profile associated with the combined serratus anterior plane block (CSAPB), a component of multimodal analgesia in patients undergoing MICS.

Methods

Twenty patients, aged 18 to 80, who underwent MICS and provided written informed consent, were included in the study. Standard cardiac anesthesia monitoring was performed. Ultrasound-guided CSAPB was performed preemptively after induction of general anesthesia as part of a multimodal analgesia strategy, using a total of 40 mL of 0.25% bupivacaine, with 20 mL administered into each of the deep and superficial serratus anterior planes. All patients received intravenous acetaminophen 1 g and tramadol 1 mg·kg− 1 at the end of surgery. Within the first 24 h, patients received 1 gram of acetaminophen every 6 h. Visual Analog Scale (VAS) scores were recorded at 0, 2, 4, 8, and 12 h after extubation. If the VAS score exceeded 40 mm at any point, the initial treatment was tramadol at a dosage of 1 mg·kg− 1. If pain continued, 0.5 mg·kg− 1 morphine was planned.

Results

The hemodynamic parameters remained within clinically acceptable ranges. In 2 patients (10%), VAS scores exceeded 40 mm, requiring rescue analgesia. A statistically significant difference was observed in terms of changes in rest VAS scores (p = 0.015). Significant differences were also observed in the changes in cough VAS scores over time (p = 0.003). Nausea and vomiting were observed in 2 patients (10%). No other complications were observed during the follow-up period.

Conclusions

Multimodal analgesia, including CSAPB, appears to be a feasible regional analgesia technique associated with low postoperative pain scores and minimal rescue analgesic requirements in patients undergoing MICS via right mini-thoracotomy.

Trial registration

Clinicaltrials Registration No: NCT06326320, Registration Date: 17/03/2024.