Comparison of the Analgesic Efficacy of Ultrasound Guided Pectoral I, Pectoral II and Serratus Anterior Plane Block Versus Intravenous Fentanyl in Patients Undergoing Off Pump Coronary Artery Bypass Grafting

Abstract

Introduction: This study was undertaken to compare the analgesic efficacy of Ultrasound-guided (USG) Pectoral block (PECS 1 and 2) and Serratus Anterior Plane (SAP) block versus intravenous fentanyl in patients undergoing off pump coronary artery bypass grafting. (OP-CABG) Methods: Sixty adult patients posted for OP-CABG were randomly assigned to two groups of 30 each. Group A was given PECS 1 & 2 with SAP Block with 0.25% Bupivacaine, 2% Lignocaine + Adrenaline and Dexamethasone up to maximum of 60 ml under USG guidance bilaterally (30ml on each side) after induction.  Group B received only intravenous Fentanyl (2mcg/kg/hour) infusion.  Patients were assessed for vitals, numerical rating scale (NRS) score and Richmond agitation sedation scale (RASS) for 48 hours. Time of extubation, duration of mechanical ventilation, total opioid consumed in 48 hours, adverse events and length of intensive care unit (ICU) and hospital stay were compared. Results: Patients in group A had significantly lower pain scores (P < 0.05) throughout the study. The total dose of intraoperative fentanyl used in Group B was significantly higher (P <0.001) than that in Group A. The total postoperative use of fentanyl (781.67 ± 354.22 mcg vs 1349.25 ± 366.88 mcg) was significantly lower (P <0.001) in group A. Comparison of median RASS revealed that majority in Group A were alert. Adverse effects, duration of ventilation, ICU and hospital stay were comparable between groups. Conclusion: In patients undergoing OP-CAB surgeries, the analgesia provided by PECS with SAP block is superior to intravenous fentanyl alone. Reduced narcotic usage resulted in optimal sedation profile in the ICU.