Clinical Research Directory

Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia in Open-Heart Surgery

Postoperative pain following open-heart surgery is a significant challenge that may negatively affect recovery and overall clinical outcomes. Due to the risks and contraindications associated with neuraxial techniques, the use of fascial plane blocks has increased in recent years. In patients undergoing cardiac surgery, the location and intensity of postoperative pain may vary daily. However, during the first 24 hours, pain is typically most pronounced at the median sternotomy incision site and at the insertion sites of chest, mediastinal, and pleural drains. Current postoperative analgesia practices in open-heart surgery commonly include multimodal regimens using simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs, combined with a regional anesthesia technique such as the parasternal block. The Serratus Posterior Superior Intercostal Plane Block (SPSIPB) is an interfascial plane block that involves the injection of local anesthetic between the serratus posterior superior and intercostal muscles, providing wide dermatomal coverage from the upper cervical to lower thoracic regions. Although the technique has been used successfully in individual clinical cases, no randomized controlled studies have been conducted to evaluate its efficacy in open-heart surgery. This study aims to compare the postoperative analgesic effectiveness of the SPSIPB with a combination of parasternal block and local anesthetic infiltration at drain insertion sites in patients undergoing open-heart surgery.

Low-Flow Anesthesia and Open-Heart Surgery

Low-flow anesthesia (LFA) is a technique in which at least 50% of the exhaled air, after carbon dioxide absorption, is mixed with a certain amount of fresh gas and returned to the patient during the next inspiration. In 1974, R. Virtue defined minimal flow anesthesia (MFA) as 0.5 L/min. In 1984, Baker and Simionescu classified LFA as 0.5-1 L/min and MFA as 0.25-0.5 L/min. The aim of this study is to investigate whether there are hemodynamic differences between open-heart surgery cases performed with LFA at different fresh gas flow rates.