Analgesic effects of thoracic fascial plane blocks in postoperative pain management following cardiac surgery with sternotomy: a retrospective study

Abstract

Aims: Acute poststernotomy pain is very severe and causes adverse hemodynamic disturbances. Various thoracic fascial plane blocks are used in the management of this pain. This study aimed to compare the analgesic effects of conventional analgesic methods and thoracic fascial plane blocks in the treatment of post-sternotomy pain. Methods: Patients aged over than 18 years and with American Society of Anesthesiologists (ASA) physical status I-II-III who underwent elective cardiac surgery with sternotomy in 2022-2023 were included in this retrospective study. Patient records were categorized into groups based on the regional analgesia preferences applied. The groups are as follows: Group I: Patients without any blocks. Group II: Patients who received parasternal block (PSB). Group III: Patients who received serratus anterior plane block (SAPB). Group IV: Patients who received erector spinae plane block (ESPB). Then, the patients’ demographic data, laboratory data, Behavioral Pain Score (BPS) values, Visual Analog Scale (VAS) values, and additional analgesia needs were recorded and compared. Results: The files of 128 patients were included in the study. The patients are statistically similar in terms of demographic data and surgical characteristics. Remifentanil consumption, BPS values, VAS values, and the need for additional analgesia were statistically lower in the groups in which thoracic fascial plane blocks were applied compared to the group in which conventional analgesia was applied. Conclusion: As a result, thoracic fascial plane blocks, which have been used increasingly frequently in recent years, can provide more effective analgesia than conventional analgesia methods in cardiac surgery. Additionally, considering enhanced recovery after surgery protocols, these blocks may reduce undesirable side effects by limiting the need for opioids in the perioperative period. Since PSB and SAPB can be applied in the supine position, they may be more advantageous than ESPB in terms of ease of application.

Keywords

• Acute pain
• cardiac surgery
• erector spinae plane block
• parasternal block
• serratus anterior plane block
• thoracic fascial plane blocks

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