Background: Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) surgery requires a surgical incision like a thoracic surgery offering a less invasive alternative to traditional midline sternotomy for cadiac surgical procedures. Intercostal nerve blocks (ICNB) play a crucial role in enhancing postoperative outcomes by minimizing pain and improving lung function.
Material and Methods: This prospective, double-blinded, randomized controlled trial aimed to assess the role of ICNB in MIDCAB procedures regarding pain reduction, expedited extubation, and improved lung function. Forty patients were randomized into two groups: one receiving ICNB with bupivacaine and the other receiving ICNB with saline (control). ICNB was administered post-surgery, and patients were transferred to the intensive care unit (ICU). Pain scores, duration of analgesia, rescue analgesic use, duration of ventilation, and inspiratory flow rates were recorded post-extubation.
Results: All patients in both groups completed the study. Patients receiving ICNB demonstrated significantly longer duration of analgesia (p<0.0001), reduced duration of ventilation (p<0.0001), fewer breakthrough pain episodes, and lower consumption of rescue analgesics compared to the control group. Pain scores in sedentary and dynamic states were consistently lower in the ICNB group at various time points post-extubation (p<0.05). Inspiratory flow rates were higher in the ICNB group throughout the study period (p<0.05).
Conclusion: Intercostal nerve blocks significantly improve postoperative outcomes in MIDCAB procedures, including prolonged analgesia, reduced ventilation time, decreased breakthrough pain, and enhanced lung function. Incorporating ICNB into perioperative management protocols can optimize patient comfort and expedite recovery following MIDCAB surgery.