Dose-Matched Parasternal Intercostal Plane Block With or Without Serratus Anterior Plane Block for Analgesia...

To compare the effects of the parasternal intercostal plane (PIP) block alone versus the PIP block in combination with the serratus anterior plane block (SAPB) on opioid consumption in patients undergoing coronary artery bypass grafting (CABG).

Prospective, randomized, controlled, observer-blinded study.

Tertiary training and research hospital.

Adult patients scheduled for elective CABG surgery via median sternotomy with bilateral thoracic drains.

Patients were randomized into two groups; 40 mL of 0.25% bupivacaine was used in both groups. In the PIP group, a bilateral PIP block was performed with 20 mL of 0.25% bupivacaine on each side. In the PIP-SAPB group, a bilateral PIP block and bilateral SAPB were performed and 10 mL of 0.25% bupivacaine was administered to each PIP block and SAPB site. The primary outcome was total tramadol consumption within the first 24 hours after extubation.

Seventy-two patients were analyzed (PIP group, n = 37; PIP-SAPB group, n = 35). Tramadol consumption was significantly lower in the PIP-SAPB group (median, 135 mg; interquartile range [IQR], 115-192.5 mg) than in the PIP group (median, 320 mg; IQR, 210-400 mg), corresponding to a Hodges-Lehmann median difference of 150 mg (95% confidence interval, 80-220 mg; p < 0.001). Numeric Rating Scale pain scores at the sternotomy site were similar between groups, whereas scores were significantly lower at the thoracic drain site in the PIP-SAPB group.

Combining the SAPB with the PIP block does not further reduce sternotomy-related pain; however, it significantly decreases postoperative opioid consumption by effectively controlling drain-related pain. The observed opioid-sparing effect and improved patient comfort indicate that this approach is clinically feasible and aligns with multimodal, component-based analgesia strategies.