Comparative Efficacy of Serratus Anterior Plane Block (SAPB) and Fentanyl for Postoperative Pain Management and Stress Response in Patients Undergoing Minimally Invasive Cardiac Surgery (MICS)

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Abstract
Background: Fast-tracking plays a significant role in reducing perioperative morbidity and postoperative hospital stay by facilitating early extubation and optimal pain control. Attenuating the stress response to surgery also has a crucial function in enhancing recovery. Serratus anterior plane block (SAPB) is a recently described technique for chest wall analgesia. More data is required to find out the effectiveness of analgesia by SAPB for minimally invasive cardiac surgery (MICS). Aim: The study aimed to assess the efficacy and safety of ultrasound-guided SAPB compared to fentanyl for controlling post-thoracotomy pain and stress response in patients undergoing MICS. Setting and Design: Time framed comparative, prospective, and observational study. Materials and Methods: Patients undergoing MICS for coronary artery bypass grafting under general anesthesia were randomly assigned into two groups. SAPB group (Group A) patients were given 0.2% of 20 ml ropivacaine followed by catheter insertion for continuous infiltration at the end of the procedure. Fentanyl group (Group B) patients were given fentanyl infusion for postoperative analgesia. The primary outcome measured changes in visual analog scale (VAS) score (pain) and cortisol levels (for stress response) in both groups. Results: VAS score was significantly low in Group A when compared to Group B (P < 0.0001). Cortisol levels were also lower in the SAPB group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, pulse rate, and oxygen saturation) were more stable in Group A with a lesser requirement of top-up analgesics. Conclusion: SAPB was more effective than fentanyl in managing post-thoracotomy pain after MICS. Cortisol level was lower in the group that received SAPB.

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