Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesia in Open-Heart Surgery

NCT07232992 | Completed

• 1 other identifier: Bursa City Hospital 003
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

Postoperative pain following open-heart surgery is a significant challenge that may negatively affect recovery and overall clinical outcomes. Due to the risks and contraindications associated with neuraxial techniques, the use of fascial plane blocks has increased in recent years. In patients undergoing cardiac surgery, the location and intensity of postoperative pain may vary daily. However, during the first 24 hours, pain is typically most pronounced at the median sternotomy incision site and at the insertion sites of chest, mediastinal, and pleural drains. Current postoperative analgesia practices in open-heart surgery commonly include multimodal regimens using simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drugs, combined with a regional anesthesia technique such as the parasternal block. The Serratus Posterior Superior Intercostal Plane Block (SPSIPB) is an interfascial plane block that involves the injection of local anesthetic between the serratus posterior superior and intercostal muscles, providing wide dermatomal coverage from the upper cervical to lower thoracic regions. Although the technique has been used successfully in individual clinical cases, no randomized controlled studies have been conducted to evaluate its efficacy in open-heart surgery. This study aims to compare the postoperative analgesic effectiveness of the SPSIPB with a combination of parasternal block and local anesthetic infiltration at drain insertion sites in patients undergoing open-heart surgery.

Conditions

Open-heart Surgery; Serratus Posterior Superior Intercostal Plane Block (SPSIPB)

Keywords

open-heart surgery; Serratus Posterior Superior Intercostal Plane Block (SPSIPB); postoperative analgesia; parasternal block

Outcome Measures

Primary Outcomes (1)

• opioid consumption

  Fentanyl will be prepared at a concentration of 10 µg/mL, and patient-controlled analgesia (PCA) will be administered without a basal infusion, using a lock-out interval of 20 minutes and a bolus dose of 20 µg.

  0, 2, 4, 8, 16 and 24 hours

Secondary Outcomes (2)

• Postoperative pain scores (Numerical rating scale) (0-meaning "no pain" to 10-meaning "worst pain imaginable")

  0, 2, 4, 8, 16 and 24 hours

• Global recovery scoring system (patient satisfaction scale)- QoR-15

  The quality of recovery will be evaluated out of a total of 150 points according to the QoR-15 test to be applied at the portoperative 24th hour.

Study Arms (2)

Group SPSIPB

ACTIVE COMPARATOR

It will be administered bilaterally before the induction of general anesthesia.

Other: SPSIPB blcok

Group Control

ACTIVE COMPARATOR

Parasternal block and local infiltration at the drain insertion site.

Other: Parasternal blocks; Other: Local Infiltration

Interventions

SPSIPB blcok OTHER

Under aseptic conditions, an ultrasound-guided procedure will be performed using a linear probe (GE ML6-15-D Matrix Linear). After identifying the second and third ribs, a 22-gauge, 50-mm short-bevel needle (Stimuplex Ultra®, Braun, Melsungen, Germany) will be advanced in-plane in a caudocranial direction. Following hydrodissection with 5 mL of saline to confirm correct needle placement, 20 mL of 0.25% bupivacaine will be injected bilaterally into the fascial plane.

Group SPSIPB

Parasternal blocks OTHER

Before intubation, the block will be performed under aseptic conditions using a high-frequency ultrasound probe (GE ML6-15-D Matrix Linear, Boston, USA) placed immediately lateral to the sternum after identifying the second to fourth intercostal spaces. An 50-mm echogenic block needle (Stimuplex Ultra®, Braun, Melsungen, Germany) will then be advanced using an in-plane approach from the skin toward the plane between the pectoralis major and intercostal muscles. A total of 10 mL of 0.25% bupivacaine will be injected bilaterally.

Group Control

Local Infiltration OTHER

Local anesthetic infiltration (10 mL of 0.25% bupivacaine) will be administered around the chest tube and mediastinal drain sites.

Group Control

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged 18-85 years with ASA physical status II-III undergoing elective open-heart surgery.

You may not qualify if:

• Patients who do not consent to participate in the study
• Patients with coagulopathy
• History of allergy or toxicity to local anesthetics
• Patients with hepatic or renal failure
• Patients with uncontrolled diabetes mellitus
• Patients with uncontrolled hypertension
• Mentally disabled patients
• Patients receiving chronic pain therapy (opioid use)
• Use of antidepressant medication
• Presence of neuropathic pain
• Presence of infection at the injection site
• Pregnant, suspected pregnant, or breastfeeding women

Sponsors & Collaborators

• Bursa City Hospital: lead
• Ulusoy, Emre, M.D.: collaborator

Study Sites (1)

Bursa City Hospital

Bursa, Turkey (Türkiye)

Location

Related Publications (1)

• Zengin EN, Yigit H, Cobas M, Salman N, Asli Demir Z. The analgesic effects of combined bilateral parasternal block and serratus anterior plane block for coronary artery bypass grafting surgery. BMC Anesthesiol. 2024 Aug 5;24(1):274. doi: 10.1186/s12871-024-02659-7.

  PMID: 39103782 BACKGROUND

MeSH Terms

Interventions

Anesthesia, Local

Intervention Hierarchy (Ancestors)

Anesthesia, Conduction; Anesthesia; Anesthesia and Analgesia

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: assoc prof

Study Record Dates

• First Submitted: November 14, 2025
• First Posted: November 18, 2025
• Study Start: January 15, 2026
• Primary Completion: April 15, 2026
• Study Completion: April 15, 2026
• Last Updated: April 29, 2026

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)