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Background <p>Ultrasound-guided pectoral nerve (PECS) and serratus anterior plane (SAP) blocks are increasingly used for perioperative analgesia in cardiac surgery. However, their effect on intraoperative physiological parameters, such as left internal mammary artery (LIMA) blood flow, remains unclear. This study aimed to evaluate the association of PECS and SAP blocks with intraoperative LIMA free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting (CABG).</p> Methods <p>In this prospective, randomized controlled trial, 150 adult patients undergoing elective, isolated, on-pump CABG were allocated to three groups: control (no block), PECS block, or SAP block (<i>n</i> = 50 per group). Blocks were performed preoperatively under ultrasound guidance. LIMA free blood flow was measured intraoperatively after harvesting under standardized hemodynamic conditions and expressed as mL/min. Hemodynamic responses to surgical incision, intraoperative opioid requirements, and vasoactive drug use were also recorded.</p> Results <p>Baseline characteristics were comparable among groups. LIMA free blood flow was higher in the PECS and SAP groups compared with the control group (mean ± SD: 83.1 ± 23.8 and 92.5 ± 21.0 vs. 60.6 ± 20.0 mL/min, respectively; <i>p</i> &lt; 0.001), with higher values observed in the SAP group compared with the PECS group (<i>p</i> &lt; 0.01). Both block groups demonstrated significantly attenuated increases in mean arterial pressure and heart rate in response to surgical incision (<i>p</i> &lt; 0.001 for all comparisons) and reduced rescue opioid requirements. Vasoactive drug use prior to LIMA flow measurement was comparable among groups.</p> Conclusions <p>PECS and SAP blocks were associated with attenuated hemodynamic responses to surgical incision and higher measured LIMA free blood flow under standardized conditions in patients undergoing CABG. These findings suggest that chest wall regional anesthesia techniques may influence intraoperative physiological parameters beyond their established analgesic effects. However, this study does not demonstrate improved graft patency, myocardial perfusion, or clinical outcomes. Further studies are warranted to determine whether these intraoperative differences translate into clinically meaningful benefits.</p> Trial registration <p>ClinicalTrials.gov NCT05907798. Registered on 23 May 2023, before the initiation of patient recruitment at our institution.</p>

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Association of pectoral nerve (PECS) and Serratus Anterior Plane (SAP) blocks with intraoperative left internal mammary artery free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting: a randomized controlled trial

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  • 发表日期：

    2026年6月2日

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  • Arzu Esen Tekeli,
  • Esra Eker,
  • Şahin Şahinalp,
  • Nureddin Yüzkat,
  • Recep Çalışkan,
  • Doğukan Çatulay,
  • Mine Uzlaş,
  • Nabil Elkassabany

摘要

Background

Ultrasound-guided pectoral nerve (PECS) and serratus anterior plane (SAP) blocks are increasingly used for perioperative analgesia in cardiac surgery. However, their effect on intraoperative physiological parameters, such as left internal mammary artery (LIMA) blood flow, remains unclear. This study aimed to evaluate the association of PECS and SAP blocks with intraoperative LIMA free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting (CABG).

Methods

In this prospective, randomized controlled trial, 150 adult patients undergoing elective, isolated, on-pump CABG were allocated to three groups: control (no block), PECS block, or SAP block (n = 50 per group). Blocks were performed preoperatively under ultrasound guidance. LIMA free blood flow was measured intraoperatively after harvesting under standardized hemodynamic conditions and expressed as mL/min. Hemodynamic responses to surgical incision, intraoperative opioid requirements, and vasoactive drug use were also recorded.

Results

Baseline characteristics were comparable among groups. LIMA free blood flow was higher in the PECS and SAP groups compared with the control group (mean ± SD: 83.1 ± 23.8 and 92.5 ± 21.0 vs. 60.6 ± 20.0 mL/min, respectively; p < 0.001), with higher values observed in the SAP group compared with the PECS group (p < 0.01). Both block groups demonstrated significantly attenuated increases in mean arterial pressure and heart rate in response to surgical incision (p < 0.001 for all comparisons) and reduced rescue opioid requirements. Vasoactive drug use prior to LIMA flow measurement was comparable among groups.

Conclusions

PECS and SAP blocks were associated with attenuated hemodynamic responses to surgical incision and higher measured LIMA free blood flow under standardized conditions in patients undergoing CABG. These findings suggest that chest wall regional anesthesia techniques may influence intraoperative physiological parameters beyond their established analgesic effects. However, this study does not demonstrate improved graft patency, myocardial perfusion, or clinical outcomes. Further studies are warranted to determine whether these intraoperative differences translate into clinically meaningful benefits.

Trial registration

ClinicalTrials.gov NCT05907798. Registered on 23 May 2023, before the initiation of patient recruitment at our institution.