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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Erector Spinae Plane Block Group | Active Comparator | Participants in this group will receive a bilateral ultrasound-guided Erector Spinae Plane Block (ESPB) for postoperative analgesia. |
|
| SPIPB and SAPB Group | Active Comparator | Participants in this group will receive a combination of bilateral ultrasound-guided Superficial Parasternal Intercostal Plane Block (SPIPB) and Serratus Anterior Plane Block (SAPB) for postoperative analgesia. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Erector spinae plane block (ESPB) | Procedure | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain Intensity (Visual Analog Scale Score) | Pain levels assessed using the Visual Analog Scale (0 = no pain, 10 = worst imaginable pain). | At 0, 1, 2, 4, 8, 12, 16 and 24 hours postoperatively. |
| Measure | Description | Time Frame |
|---|---|---|
| Extubation Time | The duration from the end of the surgical procedure until the patient is successfully extubated. | From the end of surgery until the date of successful endotracheal tube removal, assessed up to 24 hours. |
| Total Postoperative Opioid Consumption |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bursa Uludag University Hospital | Recruiting | Bursa | Nilüfer | 16235 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39583527 | Background | Yadav S, Raman R, Prabha R, Kaushal D, Yadav P, Kumar S. Randomized Controlled Trial of Ultrasound-Guided Parasternal Intercostal Nerve Block and Transversus Thoracis Muscle Plane Block for Postoperative Analgesia of Cardiac Surgical Patients. Cureus. 2024 Oct 23;16(10):e72174. doi: 10.7759/cureus.72174. eCollection 2024 Oct. | |
| 37273884 |
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The investigators do not plan to share individual participant data to protect patient privacy and comply with institutional data protection regulations.
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|
| Superficial Parasternal Intercostal Plane Block (SPIPB) | Procedure | Bilateral ultrasound-guided SPIPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for sternotomy. |
|
| Serratus Anterior Plane Block (SAPB) | Procedure | Bilateral ultrasound-guided SAPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for the chest wall. |
|
Total amount of opioid (e.g., morphine or fentanyl) administered to the patient in the first 24 hours. |
| From the end of surgery up to 24 hours postoperatively. |
| Behavioral Pain Scale (BPS) | Pain assessment based on facial expression, upper limb movement, and compliance with ventilation. | From ICU admission until extubation, assessed up to 24 hours. |
| Time to First Rescue Analgesic | The time elapsed from the end of surgery until the patient first requires additional pain medication. | From the end of surgery until the first dose of rescue analgesic, assessed up to 24 hours. |
| Zou M, Ruan W, Liu J, Xu J. Preemptive parasternal intercostal nerve block for patients undergoing off-pump coronary artery bypass grafting: a double-blind, randomized, controlled trial. Front Cardiovasc Med. 2023 May 18;10:1188518. doi: 10.3389/fcvm.2023.1188518. eCollection 2023. |
| 39470954 | Background | Balan C, Boros C, Morosanu B, Coman A, Stanculea I, Valeanu L, Sefan M, Pavel B, Ioan AM, Wong A, Bubenek-Turconi SI. Nociception level index-directed superficial parasternal intercostal plane block vs erector spinae plane block in open-heart surgery: a propensity matched non-inferiority clinical trial. J Clin Monit Comput. 2025 Feb;39(1):59-72. doi: 10.1007/s10877-024-01236-0. Epub 2024 Oct 29. |
| 32843270 | Background | Bousquet P, Labaste F, Gobin J, Marcheix B, Minville V. Bilateral Parasternal Block and Bilateral Erector Spinae Plane Block Reduce Opioid Consumption in During Cardiac Surgery. J Cardiothorac Vasc Anesth. 2021 Apr;35(4):1249-1250. doi: 10.1053/j.jvca.2020.07.021. Epub 2020 Jul 9. No abstract available. |
| 36114466 | Background | Dost B, Kaya C, Turunc E, Dokmeci H, Yucel SM, Karakaya D. Erector spinae plane block versus its combination with superficial parasternal intercostal plane block for postoperative pain after cardiac surgery: a prospective, randomized, double-blind study. BMC Anesthesiol. 2022 Sep 16;22(1):295. doi: 10.1186/s12871-022-01832-0. |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D059787 | Acute Pain |
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009422 | Nervous System Diseases |
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