Clinical Research Directory

Combined SPSP and TTP Blocks for Postoperative Analgesia Post-CABG

After heart bypass surgery (coronary artery bypass grafting, CABG), the breastbone is divided to reach the heart, which causes significant pain. Pain can make deep breathing and coughing difficult and may slow recovery. Strong pain medicines called opioids are the usual treatment, but they can cause side effects such as drowsiness, slowed breathing, nausea, vomiting, and confusion. This study tested whether two nerve blocks given together can reduce the need for opioids after bypass surgery. A nerve block is an injection of local anesthetic, guided by ultrasound, that numbs a specific area of the body. The two blocks are the serratus posterior superior plane (SPSP) block, which numbs the upper side and back of the chest wall, and the transversus thoracic plane (TTP) block, which numbs the front of the chest next to the breastbone. Both were placed on each side of the chest after the patient was asleep under general anesthesia and before surgery began. Adults aged 18 to 75 having planned (non-emergency) bypass surgery were randomly assigned, by chance, to one of two groups. One group received both blocks plus standard pain medicines. The other group received standard pain medicines alone. Patients did not know which group they were in, and the staff who measured outcomes were also unaware of group assignment. The main question was how much opioid medicine patients needed in the first 48 hours after the breathing tube was removed. Other measures included pain scores at rest and with movement, time until first rescue pain medicine, time to breathing-tube removal, oxygen levels, length of ICU and hospital stay, time to first getting out of bed, patient satisfaction, and side effects such as complications from the blocks or from opioids. The results may help doctors decide whether combining these two blocks is a useful way to control pain and reduce opioid use after heart bypass surgery.