Adults undergoing minimally invasive coronary artery bypass surgery (MIDCAB/MICS‑CABG): combined interpectoral–pectoserratus plane block versus combined deep–superficial serratus anterior plane block versus standard analgesic management for postoperative pain (VAS) and recovery quality (QoR‑40): a single‑centre randomised controlled trial
Postoperative pain and recovery after minimally invasive coronary artery bypass surgery (MIDCAB/MICS‑CABG) for coronary artery disease
This is a prospective, single‑centre, randomised, parallel‑group clinical trial (retrospectively registered; recruitment completed). Adult patients undergoing MIDCAB or MICS‑CABG are randomised 1:1:1 using a predefined randomisation list generated by an investigator not involved in enrolment or outcome assessment. Three groups are compared: Group P (combined interpectoral–pectoserratus plane block): ultrasound‑guided block performed on the left anterior chest wall after surgery. Local anaesthetic: 0.25% bupivacaine; 15 mL injected between pectoralis major and pectoralis minor muscles (interpectoral plane) plus 15 mL injected between pectoralis minor and serratus anterior (pectoserratus plane). Group S (combined deep–superficial serratus anterior plane blocks): ultrasound‑guided blocks on the left anterior chest wall at approximately the 4th–5th rib level. Local anaesthetic: total 30 mL of 0.25% bupivacaine administered across superficial (between latissimus dorsi and serratus anterior) and deep (between serratus anterior and ribs/external intercostals) planes. Control group: standard postoperative analgesic management without regional plane block. All patients receive paracetamol 1 g IV every 8 hours postoperatively. Rescue analgesia is given if VAS >40: tramadol 100 mg IV; if pain persists despite this, dexketoprofen 50 mg is administered (tramadol dosing interval ≥4 hours). Outcomes are assessed during the hospital stay. Pain intensity is measured using VAS at 6, 12, 24, and 48 hours after extubation. Quality of recovery is assessed using the QoR‑40 questionnaire preoperatively and on postoperative days 1 and 2. Patients are followed until discharge and postoperative complications and adverse events are recorded.
1. Age ≥18 years 2. Scheduled for minimally invasive coronary artery bypass surgery (MIDCAB or MICS‑CABG) 3. Provided informed consent
1. Known allergy to local anaesthetics 2. Chronic analgesic use 3. Coagulopathy 4. Infection at injection site 5. Peripheral neuropathy 6. Thoracic deformities