CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 3, May/June 2022 AFRICA 155 The RASS scores in the PECS II block group were statistically significantly higher than in the PS block group in the fourth hour (p = 0.001, p < 0.01, respectively) (Table 4). The RASS scores of the two groups did not differ significantly in the sixth, 12th and 24th hours (p > 0.05) (Table 4). Discussion The current analgesic regimens are far from providing uncomplicated and adequate postoperative analgesia after openheart surgery with sternotomy. Opioids are the first choice for postoperative analgesia after cardiac surgery as part of a multimodal analgesia and are frequently associatedwith sedation, inadequate respiratory function and delayed extubation, causing prolonged length of stay in the intensive care unit.4 Very few of these regimens provide the desired sufficient postoperative analgesia with minimal side effects. Blocking nerves in different regions with different block techniques effectively provides postoperative analgesia and reduces the use of opioids.11,12 However systemic heparinisation limits the number of methods used for postoperative analgesia after open-heart surgery with sternotomy.2,6 Based on this, our study evaluated the effectiveness of two block techniques that provide adequate postoperative analgesia after open-heart surgery. According to their study protocols, previous studies compared one of the blocks with multimodal analgesia after sternotomy in the postoperative period. In a research article conducted in India, the PECS II block was compared with multimodal analgesia after cardiac surgery for ventilation support. Pain scores, flow rates and rescue analgesia were compared. The Table 1. Comparison of characteristics between the groups Characteristics Groups p-value PECS II PS Gender Male 36 (72.0) 39 (78.0) 0.488b Female 14 (28.0) 11 (22.0) Age Mean ± SD 56.90 ± 4.08 56.88 ± 4.35 0.849a Median (min–max) 57 (48–67) 57 (45–64) BMI Mean ± SD 30.14 ± 4.19 30.78 ± 2.44 0.336a Median (min–max) 30.5 (18–39) 31 (23–35) Block duration (h) Mean ± SD 2.18 ± 0.56 5.26 ± 0.78 0.001a* Median (min–max) 2 (1–3) 5 (4–6) Ventilation duration (min) Mean ± SD 99.56 ± 15.2 97.32 ± 15.36 0.426a Median (min–max) 100 (75–135) 90 (75–135) aMann–Whitney U-test, bChi-squared test, *p < 0.05. BMI: body mass index. Table 2. Comparison of VAS score at rest between the groups VAS-R Groups p-value PECS II PS 1st hour Mean ± SD 1.4 ± 0.61 1.24 ± 0.62 0.194a Median (min–max) 1 (0–2) 1 (0–2) 2nd hour Mean ± SD 1.06 ± 0.65 0.88 ± 0.48 0.126a Median (min–max) 1 (0–2) 1 (0–2) 4th hour Mean ± SD 4.08 ± 1.19 1.38 ± 0.73 0.001a** Median (min–max) 4 (2–6) 2 (0–2) 6th hour Mean ± SD 5.36 ± 1.24 3.62 ± 0.78 0.001a** Median (min–max) 6 (2–7) 4 (2–5) 12th hour Mean ± SD 3.86 ± 1.09 3.8 ± 1.03 0.679a Median (min–max) 4 (2–6) 4 (2–6) 24th hour Mean ± SD 0.78 ± 0.95 0.86 ± 0.78 0.469a Median (min–max) 0 (0–2) 1 (0–2) aMann–Whitney U-test, **p < 0.01. VAS-R: VAS score at rest. Table 3. Comparison of cumulative morphine consumption between the groups Cumulative morphine consumption Groups p-value PECS II PS 1st hour Mean ± SD 0 ± 0 0 ± 0 – Median (min–max) 0 (0–0) 0 (0–0) 2nd hour Mean ± SD 0 ± 0 0 ± 0 – Median (min–max) 0 (0–0) 0 (0–0) 4th hour Mean ± SD 2.36 ± 0.78 0 ± 0 0.001a** Median (min–max) 2 (2–4) 0 (0–0) 6th hour Mean ± SD 4.72 ± 1.05 1.68 ± 0.74 0.001a** Median (min–max) 4 (4–8) 2 (0–2) 12th hour Mean ± SD 7.32 ± 1.19 3.84 ± 0.89 0.001a** Median (min–max) 8 (6–10) 4 (2–6) 24th hour Mean ± SD 9.04 ± 1.09 5.4 ± 1.01 0.001a** Median (min-max) 9 (8–12) 6 (4–8) aMann–Whitney U-test, **p < 0.01. Table 4. Comparison of the RASS scores between the groups RASS scores Groups p-value PECS II PS 1st hour Mean ± SD 0 ± 0 0 ± 0 – Median (min–max) 0 (0–0) 0 (0–0) 2nd hour Mean ± SD 0 ± 0 0 ± 0 – Median (min–max) 0 (0–0) 0 (0–0) 4th hour Mean ± SD 1.42 ± 0.5 0.42 ± 0.5 0.001a** Median (min–max) 1 (1–2) 0 (0–1) 6th hour Mean ± SD 1.08 ± 0.72 1.02 ± 0.62 0.632a Median (min–max) 1 (0–2) 1 (0–2) 12th hour Mean ± SD 0.2 ± 0.4 0.28 ± 0.45 0.351a Median (min–max) 0 (0–1) 0 (0–1) 24th hour Mean ± SD 0.38 ± 0.49 0.28 ± 0.45 0.290a Median (min–max) 0 (0–1) 0 (0–1) aMann–Whitney U-test, **p < 0.01. RASS: Richmond agitation–sedation scale.
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