Postoperative Pain, Sternotomy Pain, Acute Pain, Cardiac Surgery, Pain Management
Conditions
Keywords
Erector Spinae Plane Block, Serratus Anterior Plane Block, Superficial Parasternal Intercostal Plane Block, Opioid Consumption, Multimodal Analgesia
Brief summary
This study aims to compare the effectiveness of two regional anesthesia techniques in managing pain for participants undergoing cardiac surgery via sternotomy. The investigators will evaluate whether the Erector Spinae Plane Block (ESPB) or a combination of the Superficial Parasternal Intercostal Plane Block (SPIPB) and Serratus Anterior Plane Block (SAPB) provides better pain control and recovery outcomes.
Detailed description
The investigators aim to compare the effects of the erector spinae plane block (ESPB) versus the combination of superficial parasternal intercostal plane block (SPIPB) and serratus anterior plane block (SAPB) in the management of postoperative sternotomy pain among participants scheduled for cardiac surgery via sternotomy. Study design and methods: A total of 50 participants (aged 18-80, ASA I-III) scheduled for sternotomy will be randomly assigned to one of two groups: ESPB Group: Participants receive the Erector Spinae Plane Block. SPIPB + SAPB Group: Participants receive a combination of both blocks. Prior to the induction of general anesthesia, participants are randomized into two groups: the ESPB group and the SPIPB + SAPB group. Nerve blocks are performed in both groups. Visual Analog Scale (VAS) scores at rest and during coughing, intraoperative opioid consumption, postoperative behavioral pain scores, extubation times, and time to the first rescue analgesic requirement are evaluated.
Interventions
PROCEDUREErector spinae plane block (ESPB)
Bilateral ultrasound-guided ESPB is performed at the T4 or T5 vertebral level. Following skin preparation and visualization of the transverse process and erector spinae muscle, a block needle is inserted. After confirming the needle tip position between the muscle and the transverse process, 0.5 mL/kg of 0.25% Bupivacaine is injected on each side.
PROCEDURESuperficial Parasternal Intercostal Plane Block (SPIPB)
Bilateral ultrasound-guided SPIPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for sternotomy.
PROCEDURESerratus Anterior Plane Block (SAPB)
Bilateral ultrasound-guided SAPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for the chest wall.
Sponsors
Uludag University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged between 18 and 80 years. * Patients classified as American Society of Anesthesiologists (ASA) physical status I, II, or III. * Patients scheduled for elective cardiac surgery via median sternotomy. * Patients who have provided written informed consent.
Exclusion criteria
* Pregnancy or suspected pregnancy. * Body Mass Index (BMI) \> 35 kg/m². * Known allergy or hypersensitivity to local anesthetics (e.g., bupivacaine). * Suspected coagulopathy or bleeding disorders. * Infection at the site of the regional block injection. * Severe hepatic or renal failure. * Severe neurological or psychiatric disorders. * Emergency surgical procedures. * Re-operation cases (Redo-surgery)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity (Visual Analog Scale Score) | At 0, 1, 2, 4, 8, 12, 16 and 24 hours postoperatively. | Pain levels assessed using the Visual Analog Scale (0 = no pain, 10 = worst imaginable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Extubation Time | From the end of surgery until the date of successful endotracheal tube removal, assessed up to 24 hours. | The duration from the end of the surgical procedure until the patient is successfully extubated. |
| Total Postoperative Opioid Consumption | From the end of surgery up to 24 hours postoperatively. | Total amount of opioid (e.g., morphine or fentanyl) administered to the patient in the first 24 hours. |
| Behavioral Pain Scale (BPS) | From ICU admission until extubation, assessed up to 24 hours. | Pain assessment based on facial expression, upper limb movement, and compliance with ventilation. |
| Time to First Rescue Analgesic | From the end of surgery until the first dose of rescue analgesic, assessed up to 24 hours. | The time elapsed from the end of surgery until the patient first requires additional pain medication. |
Countries
Turkey (Türkiye)
Outcome results
None listed