This prospective randomized controlled trial aims to evaluate the effectiveness of the serratus posterior superior intercostal plane block (SPSIPB) as part of a multimodal analgesia strategy in patients undergoing minimally invasive cardiac surgery. Sixty adult ASA III patients scheduled for minimally invasive coronary artery bypass surgery will be randomly assigned to either an SPSIPB group or a control group receiving standard analgesic management without a plane block. The primary outcome is postoperative opioid (tramadol) consumption, while secondary outcomes include intraoperative remifentanil consumption, pain scores at rest and during coughing, time to first rescue analgesia, time to extubation, and lengths of intensive care unit and hospital stay.
All patients will receive standardized general anesthesia and postoperative patient-controlled analgesia. Pain intensity will be assessed using the Numeric Rating Scale at predefined postoperative intervals. Postoperative complications such as nausea, vomiting, and atelectasis will be recorded. This study aims to determine whether SPSIPB provides effective opioid-sparing analgesia and improves postoperative recovery parameters in minimally invasive cardiac surgery.
Adults aged 18 years or older
American Society of Anesthesiologists (ASA) physical status III
Scheduled for elective minimally invasive coronary artery bypass surgery
Ability to understand the study procedures and provide written informed consent
Age under 18 years
ASA physical status other than III
Pregnancy
Emergency surgery
Parallel
Serratus Posterior Superior Intercostal Plane Block
Procedure/SurgeryThe serratus posterior superior intercostal plane block is performed under ultrasound guidance before surgery, with the patient in the lateral position. After identification of the third rib and the serratus posterior superior muscle, a local anesthetic solution is injected between the muscle and the rib to provide thoracic wall analgesia as part of a multimodal pain management strategy.
Bupivacaine
DrugBupivacaine was administered as the local anesthetic for the block.
Ultrasound
DeviceUltrasound guidance was used for block placement.
Postoperative Opioid Consumption
Total postoperative opioid consumption measured as cumulative tramadol dose administered via patient-controlled analgesia during the first 24 postoperative hours.
Intraoperative Opioid Consumption
Total remifentanil consumption recorded throughout the intraoperative period.
Postoperative Pain Intensity (NRS)
Pain intensity assessed using the Numeric Rating Scale (NRS; 0 = no pain, 10 = worst imaginable pain) at rest and during coughing.
Time to First Rescue Analgesia
Time elapsed from the end of surgery to the first administration of rescue analgesic medication.
Time to Extubation
Duration from completion of surgery to successful tracheal extubation.
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