Analgesic Efficacy of Parasternal Block Versus Parasternal Plus Serratus Anterior Plane Block After Coronary Bypass Surgery

NCT07299760 | Completed DMC

• 1 other identifier: PS_SAPB
• Study Type: interventional
• Target: 72
• Locations: 1 country
• Sites: 1

Brief Summary

This single-centre randomized clinical trial will compare two regional anaesthesia techniques for postoperative pain control in adult patients undergoing elective coronary artery bypass grafting (CABG) with sternotomy. All patients will receive a bilateral parasternal block as part of routine multimodal analgesia. Patients will be randomized to receive either parasternal block alone or a combination of parasternal block and serratus anterior plane block. The primary objective is to evaluate whether adding a serratus anterior plane block improves postoperative pain scores compared with parasternal block alone. Secondary objectives include comparing opioid consumption, need for rescue analgesics, opioid-related side effects, and length of stay in the intensive care unit and hospital.

Conditions

Coronary Artery Bypass Grafting

Outcome Measures

Primary Outcomes (1)

• Total Tramadol Consumption

  Cumulative dose of tramadol (mg) delivered by patient-controlled analgesia (PCA) in the first 24 hours post-extubation

  24-hour post-extubation

Secondary Outcomes (2)

• Resting Numeric Rating Scale (NRS) Pain Score

  24 hour post-extubation

• Dynamic Numeric Rating Scale (NRS) Pain Score

  24-hour post-extubation

Study Arms (2)

Arm A: Parasternal Block

ACTIVE COMPARATOR

After induction of general anaesthesia and before skin incision, an ultrasound-guided bilateral parasternal intercostal plane block will be performed.

Procedure: parasternal block

Arm B: Serratus Anterior Plane Block

EXPERIMENTAL

In addition to the bilateral parasternal block described for the comparator arm, patients randomized to the experimental arm will receive an ultrasound-guided bilateral serratus anterior plane block.

Procedure: parasternal block; Procedure: parasternal block + serratus anterior plane block

Interventions

parasternal block PROCEDURE

After induction of general anaesthesia and before skin incision, an ultrasound-guided bilateral parasternal intercostal plane block will be performed. A linear ultrasound probe will be placed parasagittally at the 2nd and 4th intercostal spaces approximately 2-3 cm lateral to the sternum. A block needle will be advanced in-plane beneath the pectoralis major muscle and above the internal intercostal muscles, and local anaesthetic (0.25% bupivacaine) will be injected bilaterally. Total dose will not exceed 2 mg/kg. Postoperative systemic analgesia (patient-controlled analgesia) will be identical in both groups.

Arm A: Parasternal Block; Arm B: Serratus Anterior Plane Block

parasternal block + serratus anterior plane block PROCEDURE

In addition to the bilateral parasternal block described for the comparator arm, patients randomized to the experimental arm will receive an ultrasound-guided bilateral serratus anterior plane block. With the patient in supine position, the linear ultrasound probe will be placed over the 6th rib in the anterior axillary line. The needle will be advanced in-plane beneath the serratus anterior muscle and above the rib, and 0.25% bupivacaine will be injected into the fascial plane on each side. The combined total dose of local anaesthetic for both blocks will not exceed 2 mg/kg. Postoperative systemic analgesia will be identical in both groups.

Arm B: Serratus Anterior Plane Block

Eligibility Criteria

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

You may qualify if:

• Age ≥ 18 years
• American Society of Anesthesiologists (ASA) physical status III-IV
• Scheduled for elective coronary artery bypass grafting surgery with sternotomy for coronary artery disease
• Able to provide written informed consent

You may not qualify if:

• Allergy or contraindication to local anaesthetic agents
• Minimally invasive bypass surgery or off-pump procedures planned
• Emergency cardiac surgery
• Preoperative Numeric Rating Scale (NRS) pain score ≥ 3
• Chronic opioid use in the preoperative period
• Infection or structural abnormality at planned block sites
• Any condition preventing postoperative pain assessment or PCA use (e.g. severe cognitive impairment)

Sponsors & Collaborators

• Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital: lead

Study Sites (1)

Etlik City Hospital

Yenimahalle, Ankara, 06810, 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 RESULT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Attending anesthesiologist

Study Record Dates

• First Submitted: December 10, 2025
• First Posted: December 23, 2025
• Study Start: September 1, 2025
• Primary Completion: December 1, 2025
• Study Completion: January 1, 2026
• Last Updated: January 13, 2026

Record last verified: 2026-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF
• Time Frame: De-identified individual participant data underlying the primary publication may be shared upon reasonable request to the principal investigator after publication of the results.
• Access Criteria: De-identified individual participant data underlying the primary publication may be shared upon reasonable request to the principal investigator after publication of the results.

Locations

TU (1)