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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
50
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.
Bilateral ultrasound-guided SPIPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for sternotomy.
Bilateral ultrasound-guided SAPB is performed. 0.25% Bupivacaine is administered. This is part of a combined regional analgesia technique for the chest wall.
Bursa Uludag University Hospital
Bursa, Nilüfer, Turkey (Türkiye)
RECRUITINGPain Intensity (Visual Analog Scale Score)
Pain levels assessed using the Visual Analog Scale (0 = no pain, 10 = worst imaginable pain).
Time frame: At 0, 1, 2, 4, 8, 12, 16 and 24 hours postoperatively.
Extubation Time
The duration from the end of the surgical procedure until the patient is successfully extubated.
Time frame: From the end of surgery until the date of successful endotracheal tube removal, assessed up to 24 hours.
Total Postoperative Opioid Consumption
Total amount of opioid (e.g., morphine or fentanyl) administered to the patient in the first 24 hours.
Time frame: 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.
Time frame: 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.
Time frame: From the end of surgery until the first dose of rescue analgesic, assessed up to 24 hours.
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