Background and rationale {6a}
pain
MINOR, COMPLICATION
A multidisciplinary approach in perioperative care is crucial for improving patient recovery after major surgery. The so-called Enhanced Recovery After Surgery (ERAS) is an evidence-based protocol ranging from preoperative patient optimization to intra- and postoperative strategies aiming to improve clinical outcomes and reduce hospital stays. With the introduction of minimally invasive cardiac surgery (MICS) through two or three small thoracotomies, ERAS strategies gained popularity, and recently, ERAS guidelines for cardiac surgery have been presented, emphasizing that critical factors that keep patients hospitalized after major cardiac surgery are among others, perioperative pain, prolonged mechanical ventilation, and immobilization [Apart from less invasive surgical techniques, implementing a multimodal concept for pain therapy, including regional anesthesia, is an essential element of ERAS pathways [Ultrasound-guided, interfacial plane blocks represent a relatively new route of transmitting local anesthetics to the space between two fascial layers to provide the blockade of nerves traveling within this plane, leading to analgesia of the chest or abdominal wall. These blocks have already been shown to be relatively easy to perform and to have low complication risks [The pectoral nerves (PECS) II block was initially introduced in 2012 as an extension of the PECS I block (injection of local anesthetic between the pectoralis major and pectoralis minor muscles), involving a second injection in the fascial plane between pectoralis minor and serratus anterior muscles [Therefore, this prospective, triple-blinded, randomized trial aims to evaluate the efficacy of the PECS II block in patients undergoing unilateral MICS.