Abstract No. : ABS3263: Comparison of efficacy of ultrasound guided pectoral blocks plus serratus anterior plane block versus ultrasound guided erector spinae block with fentanyl group as control for analgesia in patients undergoing off-pump coronary artery bypass Grafting.

BACKGROUND & AIMS: To compare the efficacy of Ultrasound-guided Pectoral block (PECS 1&2) plus Serratus Anterior Plane (SAP) block versusErector Spinae Plane (ESP) block for post-op analgesia in patients undergoing Off-Pump Coronary Artery Bypass Grafting(OPCAB). Postoperative analgesia in terms of Numerical Rating Scale (NRS) pain scores at rest (static) and during movement (dynamic) was taken as the primary outcome. Haemodynamic variations,opioid consumption at 48 hours postoperative, time to mobilisation, level of pain at rest and after mobilisation and complications were noted as secondary outcomes. METHODS: 81 American Society of Anesthesiologists Grade III and IV patients between 35 -70 years, undergoing off-pump coronary artery bypass grafting were recruited. Patients were randomly allocated into three groups, each with 27 subjects: (Group A: Pectoral +Serratus anterior plane block group; Group B: Erector spinae block group ;Group C: Control group with only intravenous opioids).10 ml of 0.25% Bupivacaine + 1% Lignocaine with adrenaline (1 in 2 Lac)+8 mg dexamethasone was givenultrasound guidedPECS 1 and 2 & SAP- 10 ml; on either side and 30ml on either side for Erector spinae block. RESULTS: ESP block had comparable analgesic profile as PECS +SAPB at rest andduring movement in terms of NRS pain scores. Total perioperative opioid consumption was markedly decreased with the supplementation of newer blocktechniques, and better sedation profile wasobserved. The need for rescue analgesia was markedly reduced in block groups.Haemodynamic variationsduration of postoperative ventilation, ICU and hospital stay were comparable in all the three groups. CONCLUSION: The study concluded that regional blocks were superior to intravenous fentanyl for postoperative pain relief following cardiacsurgery. The use of narcotics leads to poor pain relief and greater sedation in the postoperative period.