Serratus Anterior Plan Block (SAP) and Pectoralis (PECSI-II) Blocks on Left Internal Mammarian Artery (LIMA) Blood Flow

Coronary artery bypass grafting (CABG), also known as heart bypass surgery, is a procedure performed to improve reduced blood flow due to narrowing of the coronary arteries. The left internal mammary artery (LIMA) is generally the preferred perforator artery for grafting of the left anterior descending (LAD) coronary artery from the coronary arteries. However, spasm during the release phase for anastomosis often complicates surgical dissection and anastomosis, and adversely affects flow dynamics (1) LIMA has been used as an important potential graft in coronary artery bypass graft (CABG) surgery since the 1970s. LIMA has a potent biological function through the production of vasodilator and platelet inhibitory factors. LIMA's feature of having less fenestration, lower intimal hyperplasia tendency and less permeability in intercellular connections prevents lipoproteins from entering the subendothelial space (2) The use of ultrasound in anesthesia practice, especially for analgesia, is increasingly popular. The sonoanatomical dominance of anesthetists on regional structures is increasing, especially with plan blocks, a new one being defined every day. The primary aim of this study was to investigate the effect of the ultrasound guided papaverine application method and the traditional method of topical papaverine application on the LIMA flow measured before and after anastomosis. Papaverine will be administered to all patients after the block procedure at the beginning of the surgical procedure.

Inclusion criteria

• Agreeing to participate in the study
• 20-65 years old
• ASA I-II-III
• Coronary artery bypass grafting will be performed

Exclusion criteria

• Refusal to participate in the study
• Patients under the age of 20, over the age of 65
• presence of pregnancy
• Bleeding diathesis
• Liver or kidney failure
• Acute and bleeding patients Those who receive inotropic support starting from the preoperative period
• BMI ≥30