Combine Serratus Anterior Plane Block Versus Erector Spinae Plane Block in Coronary Bypass Surgery

Study Overview
=================
Brief Summary
-----------------
Even though Erector Spinae Plane (ESP) Block is shown to be efficient in cardiac surgery, the Combine Serratus Anterior Plane (CSAP) Block is still controversial if it has an efficient analgesic effect for sternotomy and drain tube pain relief. This study aims to compare ESP block and CSAP block for postoperative analgesia in coronary bypass surgery patients.

Detailed Description
-----------------
Acute postoperative pain after cardiac surgery originates various surgical procedures that may cause pain including the incision of tissues, sternotomy, the separation of bone-joint structures, the severity and duration of these applications, the use of chest tubes, and the patient's personal inflammatory may affect the response to these stimuli. Postoperative pain is a critical risk factor for the development of pulmonary and cardiovascular complications such as atelectasis, cardiac ischemia, and arrhythmias. Researchers claim that adding techniques to iv drugs, such as thoracic epidural anesthesia, paravertebral block, or erector spinae plane block (ESP) to multimodal analgesia regimens positively affect recovery. Although the efficacy of ESP block in providing postoperative analgesia has been demonstrated in many studies, there is no study comparing CSAP and ESP block in cardiac surgery.

Official Title
-----------------
Comparison of Postoperative Analgesic Efficacy of Combine Serratus Anterior Plane Block and Erector Spinae Plane Block in Coronary Bypass Surgery: Randomized Controlled Study

Conditions
-----------------
Cardiac Surgery, Postoperative Pain, Regional Anesthesia Morbidity

Intervention / Treatment
-----------------
* Procedure: ESP block
* Procedure: CASP block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult patients who will undergo coronary artery bypass grafting surgery with median sternotomy Exclusion Criteria: Emergency surgeries Patients with allergic reactions to anesthesia and analgesia drugs to be used Patients who do not want to participate in the study voluntarily Severe systemic disease (kidney, liver, pulmonary, endocrine) Substance abuse history History of chronic pain Psychiatric problems and communication difficulties Patients who need revision due to hemostasis in the postoperative period Patients with severe hemodynamic instability due to infection, heavy bleeding, etc.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Erector Spinae Plane Block<br>An erector spinae plane block will be performed at the level of the 5th thoracic vertebrae with 30 mL of 0.25% bupivacaine solution under ultrasound guidance before the operation. | Procedure: ESP block<br>* Preoperative, awake, bilateral, ultrasound-guided erector spinae plane block with 30 mL 0.25 % bupivacaine<br>|
| Active Comparator: Combine Serratus Anterior Plane Block<br>Combine Serratus Anterior Plane block will be performed at the level of 5th costa with 30 mL of 0.25% bupivacaine (15 mL superficial serratus plane block and 15 mL deep serratus plane block) solution under ultrasound guidance before the operation. | Procedure: CASP block<br>* Preoperative, awake, bilateral, ultrasound-guided combine serratus anterior plane block with 30 mL 0.25 % bupivacaine<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative 2 hour measurement | patients will be evaluated in terms of the visual analog pain scale, the scale has a range of 0 to 10. The scale will be shown to patients and 0 means the patient has no pain, 10 means the patient feels the most pain ever felt. | 2 hour after ICU admission, an average of 5 minutes | 
| Postoperative 4 hour measurement | patients will be evaluated in terms of the visual analog pain scale, the scale has a range of 0 to 10. The scale will be shown to patients and 0 means the patient has no pain, 10 means the patient feels the most pain ever felt. | 4 hour after ICU admission, an average of 5 minutes | 
| Postoperative 6 hour measurement | patients will be evaluated in terms of the visual analog pain scale, the scale has a range of 0 to 10. The scale will be shown to patients and 0 means the patient has no pain, 10 means the patient feels the most pain ever felt. | 6 hour after ICU admission, an average of 5 minutes | 
| Postoperative 12 hour measurement | patients will be evaluated in terms of the visual analog pain scale, the scale has a range of 0 to 10. The scale will be shown to patients and 0 means the patient has no pain, 10 means the patient feels the most pain ever felt. | 12 hour after ICU admission, an average of 5 minutes | 
| Postoperative 24 hour measurement | patients will be evaluated in terms of the visual analog pain scale, the scale has a range of 0 to 10. The scale will be shown to patients and 0 means the patient has no pain, 10 means the patient feels the most pain ever felt. | 24 hour after ICU admission, an average of 5 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mechanical ventilation duration | he total time until patients suitable for endotracheal extubation | postoperative, approximately 4 to 10 hours | 
| Intensive care unit duration | The total time until patients suitable for discharge from intensive care unit | postoperative, approximately 12 to 36 hours | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
erector spinae plane block, combined serratus anterior plane block, sternotomy