Pre-emptive combined serratus anterior plane block and early recovery after minimally ınvasive direct coronary artery bypass: a retrospective cohort study.

OBJECTIVE: Minimally invasive direct coronary artery bypass (MIDCAB) via left anterior thoracotomy causes substantial early pain requiring opioids. The serratus anterior plane block (SAPB) is opioid-sparing, but data on a pre-emptive combined approach are limited. We evaluated its association with opioid administration and early recovery. METHODS: Adults undergoing MIDCAB (January-December 2025) were retrospectively grouped by pre-emptive combined SAPB versus standard systemic analgesia. The primary outcome was 24-h postoperative intravenous morphine administration. Secondary outcomes were total morphine-equivalent administration including rescue tramadol, visual analogue scale pain scores, rescue analgesia, time to extubation, intensive care unit (ICU) and hospital stay, and opioid-related adverse events. RESULTS: Sixty-four patients were analyzed (SAPB, n = 33; control, n = 31). Twenty-four-hour intravenous morphine administration was lower with SAPB (9.15 ± 2.56 vs 12.71 ± 3.71 mg, p < 0.001), as was total morphine-equivalent administration (9.72 ± 3.14 vs 19.11 ± 5.80 mg, p < 0.001). Pain scores were lower at 12 h (1 [0-2] vs 4 [3-5]) and 24 h (0 [0-1] vs 3 [2-4]) (both p < 0.001), rescue analgesia was less frequent (6.1% vs 74.2%, p < 0.001), and extubation was earlier (4 [4, 5] vs 8 [6-10] hours, p < 0.001). ICU stay showed a non-significant trend (p = 0.052) and hospital stay was similar (p = 0.414). Opioid-related adverse events did not differ significantly (9.1% vs 29.0%, p = 0.057). CONCLUSIONS: Pre-emptive combined SAPB was associated with lower opioid administration, better pain control, and earlier extubation after MIDCAB.