Aslı Z. DEMİR, Aslıhan AYKUT, Nevriye SALMAN

Medyan Sternotomili Kardiyak Cerrahide Ultrason Kılavuzluğunda Yüzeysel Serratus Anterior Plan Bloğu: Retrospektif Çalışma

Amaç: Kardiyak cerrahide multimodal analjezinin bir parçası olarak serratus anterior plan bloğu (SAPB) genellikle torakotomi ile minimal invaziv cerrahi müdahaleler için kullanılmaktadır. Çalışmamızın amacı, sternotomi ile yapılan kardiyak cerrahi için SAPB’nin analjezik etkinliğini belirlemektir. Yöntem: Koroner arter baypas greftleme (KABG) cerrahisi için SAPB (Grup SAP, n=43) ve geleneksel analjezi (Grup C, n=56) yöntemi uygulanan toplam 99 hasta retrospektif olarak karşılaştırıldı. Demografik veriler, postoperatif opioid kullanımı, en yüksek ağrı skorları, bulantı-kusma, oral alıma başlama süresi, ekstübasyon süresi, yoğun bakım ünitesi ve hastanede kalış süresi kaydedildi. Bulgular: Ekstübasyondan sonraki ilk 24 saat içinde SAPB yapılan hastalarda tüketilen toplam opioid miktarının anlamlı derecede düşük olduğu bulunmuştur (p=0.022). Benzer şekilde, dinlenme ve mobilizasyon sırasında bildirilen en yüksek ağrı skorları ve bulantı skorlarının aynı dönemde grup SAP’da anlamlı derecede düşük olduğu bulunmuştur (p=0.007, p=0.048, p=0,004). Grup SAP’da ekstübasyon (p= 0.025) ve oral alım başlama süresi (p=0.030) daha kısaydı. Sonuç: Serratus anterior plan bloğu, göğüs tüpü drenaj bölgesinin analjezisini sağlayarak, medyan sternotomi ile KABG uygulanan hastalarda daha düşük opioid tüketimi, ağrı ve bulantı-kusma ile ilişkiliydi. Bu açılardan, yüzeysel SAPB, kalp cerrahisinde opioid azaltıcı multimodal analjezinin bir parçası olabilir.

Ultrasound-Guided Superficial Serratus Anterior Plane Block for Cardiac Surgery with Median Sternotomy: A Retrospective Study

Objective: As part of multimodal analgesia regimen in cardiac surgery, the serratus anterior plane block (SAPB) is a technique regularly used in minimally invasive surgical interventions with thoracotomy. The aim of our study is to determine the analgesic efficacy of SAPB for cardiac surgery performed with sternotomy. Methods: A total of 99 patients who underwent SAPB (Group SAP, n=43) and conventional analgesia (Group C, n=56) for coronary artery bypass graft (CABG) surgery were compared retrospectively. Demographic data, postoperative opioid use, highest pain scores, nausea-vomiting, time to start oral intake, extubation time, lenght of intensive care unit and hospital stay were recorded. Results: Total opioid requirement, expressed in oral morphine equivalent within the first 24 hours after extubation, was found to be significantly lower in patients with SAPB (p=0.022). Similarly, both the highest reported pain scores at rest and during mobilization and also the nausea scores were found to be significantly lower in Group SAP during the same period (p=0.007, p=0.048, p=0.004). Extubation (p=0.025) and oral intake initiation time p=0.030) were shorter in Group SAP. Conclusion: By providing analgesia of the chest tube drain site, SAPB application was associated with lower opioid consumption, pain, and nausea-vomiting among patients who underwent CABG with median sternotomy. Because of this benefit, superficial SAPB may be part of opioid-reducing multimodal analgesia in cardiac surgery.

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