Comparison of Erector Spinae Plane Block (ESPB) With the Combination of Superficial Parasternal Intercostal Plane Block (SPIPB) and Serratus Anterior Plane Block (SAPB) in the Management of Postoperative Sternotomy Pain in Patients Undergoing Cardiac Surgery Via Sternotomy

NCT07472296 | Recruiting

• 1 other identifier: 25-AKD-251
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Postoperative Pain; Sternotomy Pain; Acute Pain; Cardiac Surgery; Pain Management

Keywords

Erector Spinae Plane Block; Serratus Anterior Plane Block; Superficial Parasternal Intercostal Plane Block; Opioid Consumption; Multimodal Analgesia

Outcome Measures

Primary Outcomes (1)

• 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.

Secondary Outcomes (4)

• Extubation Time

  From the end of surgery until the date of successful endotracheal tube removal, assessed up to 24 hours.

• Total Postoperative Opioid Consumption

  From the end of surgery up to 24 hours postoperatively.

• Behavioral Pain Scale (BPS)

  From ICU admission until extubation, assessed up to 24 hours.

• Time to First Rescue Analgesic

  From the end of surgery until the first dose of rescue analgesic, assessed up to 24 hours.

Study Arms (2)

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.

Procedure: Erector spinae plane block (ESPB)

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.

Procedure: Superficial Parasternal Intercostal Plane Block (SPIPB); Procedure: Serratus Anterior Plane Block (SAPB)

Interventions

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.

Erector Spinae Plane Block Group

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.

SPIPB and SAPB Group

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.

SPIPB and SAPB Group

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients aged between 18 and 80 years.
• Patients classified as American Society of Anesthesiologists (ASA) physical status I, II, or III.
• Patients scheduled for elective cardiac surgery via median sternotomy.
• Patients who have provided written informed consent.

You may not qualify if:

• Pregnancy or suspected pregnancy.
• Body Mass Index (BMI) \> 35 kg/m².
• Known allergy or hypersensitivity to local anesthetics (e.g., bupivacaine).
• Suspected coagulopathy or bleeding disorders.
• Infection at the site of the regional block injection.
• Severe hepatic or renal failure.
• Severe neurological or psychiatric disorders.
• Emergency surgical procedures.
• Re-operation cases (Redo-surgery)

Sponsors & Collaborators

• Uludag University: lead

Study Sites (1)

Bursa Uludag University Hospital

Bursa, Nilüfer, 16235, Turkey (Türkiye)

RECRUITING

Related Publications (5)

• 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.

  PMID: 39583527 BACKGROUND

• 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.

  PMID: 37273884 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.

  PMID: 39470954 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.

  PMID: 32843270 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.

  PMID: 36114466 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Acute Pain; Agnosia

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms; Perceptual Disorders; Neurobehavioral Manifestations; Nervous System Diseases

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
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Anesthesiology Resident

Study Record Dates

• First Submitted: March 5, 2026
• First Posted: March 16, 2026
• Study Start: November 1, 2025
• Primary Completion (Estimated): October 1, 2026
• Study Completion (Estimated): November 1, 2026
• Last Updated: March 16, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)