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Influence of Superficial Parasternal Intercostal Plane Block (SPIPB) on Internal Thoracic Artery (ITA) Caliber and Surgical Harvesting Efficiency in Coronary Artery Bypass Grafting (CABG)
Parasternal intercostal blocks (PSB) represent a newer approach to post-sternotomy pain management. Studies suggest their effectiveness in providing postoperative analgesia , with a significant advantage being their suitability even during concurrent antiplatelet or anticoagulant therapy.In addition to its sympatholytic effects cause vasodilatation , a reduction in vascular resistance, and an increase in local blood flow . The effects are maintained up to the early postoperative period .
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bupivacaine group | Active Comparator | 10 ml of bupivacaine solution will be administered. Dose: 10 ml bupivacaine concentration 0.5% (each 1 ml contains 5 mg; total volume 10 ml equivalent to total 50 mg) will be given. |
|
| Control group | No Intervention | No intervention will be administered |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bupivacaine | Drug | Superficial parasternal block will be given to assess diameter of IMA by using US to assess caliber and ease of harvesting. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Internal Thoracic Artery (ITA) Diameter | Change in the diameter of the Internal Thoracic Artery (ITA) measured in millimeters (mm) after SPIPB administration. | Measured 15 minutes after the SPIPB injection by intraoperative ultrasound. |
| Change in Internal Thoracic Artery (ITA) Cross-Sectional Area | Change in the cross-sectional area of the Internal Thoracic Artery (ITA) measured in square millimeters (mm²) after SPIPB administration. | Measured 15 minutes after the SPIPB injection by Intraoperative ultrasound. |
| Measure | Description | Time Frame |
|---|---|---|
| Time Required for ITA Harvesting | Total time in minutes (min) required to harvest the Internal Thoracic Artery. | Measured during the surgical harvesting procedure. |
| Technical Difficulty of ITA Harvesting |
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Inclusion Criteria:
• Age group: Adult patients from age of 22 to 65 years.
Exclusion Criteria:
• Patients with pre-existing active bloodstream infection or systemic infection
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sarah hamdy Elghareeb, MD | Contact | +201012434690 | sarahhamdy@med.asu.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| Sarah H Elghareeb, MD | Ain Shams | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Medicine ,Ain Shams University | Cairo | Cairo Governorate | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Background | Bupivacaine Dosage Guide + max dose, adjustments. Drugs.com. Accessed April 18, 2026. https://www.drugs.com/dosage/bupivacaine.html#Usual_Adult_Dose_for_Local_Anesthesia. | ||
| 39505578 | Background | Walker JW, Cios TJ. Local Anesthetic Choice for Regional Techniques in Cardiac Surgery: The Sauce Matters. J Cardiothorac Vasc Anesth. 2025 Jan;39(1):8-12. doi: 10.1053/j.jvca.2024.10.029. Epub 2024 Oct 18. No abstract available. | |
| 37974241 |
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Receive parasternal block
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Assessed using a Technical Difficulty Scale. The scale ranges from 1 (Very Easy) to 5 (Very Difficult), where a higher score indicates a worse outcome (more difficult harvesting).
| Assessed by the surgeon immediately after the harvesting procedure. |
| Postoperative Pain Score | Postoperative pain assessed using the Visual Analog Scale (VAS) for pain. The scale ranges from 0 mm (No Pain) to 100 mm (Worst Possible Pain), where a higher score indicates a worse outcome. | Measured at 24 hours postoperatively. |
| Postoperative Opioid Consumption | Total postoperative opioid consumption, measured in Morphine Milligram Equivalents (MME). | Measured over the first 24 hours postoperatively. |
| Intraoperative Hemodynamic Stability | Incidence of significant hemodynamic instability (e.g., episodes of hypotension or hypertension requiring intervention). | Measured during the intraoperative period. |
| Background |
| Toscano A, Capuano P, Perrucci C, Giunta M, Orsello A, Pierani T, Costamagna A, Tedesco M, Arcadipane A, Sepolvere G, Buono G, Brazzi L. Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study. J Anesth Analg Crit Care. 2023 Nov 16;3(1):48. doi: 10.1186/s44158-023-00134-2. |
| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
| D000588 | Amines |
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