Postoperative Analgesia and Ventilation After Cardiac Surgery

NCT07475884 | Completed

• 1 other identifier: 2025-15/13
• Study Type: observational
• Target: 206
• Locations: 1 country
• Sites: 1

Brief Summary

Cardiac surgery performed via median sternotomy is associated with significant postoperative pain due to extensive tissue trauma, sternal bone healing, and mediastinal retraction. Inadequately controlled postoperative pain represents an important source of morbidity in these patients and may adversely affect respiratory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. These complications can delay extubation, prolong the duration of mechanical ventilation, and increase the length of stay in the intensive care unit (ICU). In addition, insufficient pain control may trigger sympathetic activation, resulting in increased myocardial oxygen consumption, a higher risk of arrhythmias, and impaired immune function. Traditionally, systemic opioids have been the cornerstone of postoperative pain management in cardiac surgery; however, opioid-based analgesia is associated with several adverse effects, including respiratory depression, sedation, nausea and vomiting, gastrointestinal dysfunction, and prolonged mechanical ventilation. These limitations have led to increasing interest in multimodal analgesia strategies aimed at improving postoperative pain control while reducing opioid consumption and related complications. In this context, regional analgesia techniques have emerged as important components of multimodal pain management protocols in cardiac surgery. The aim of this study was to evaluate the effects of fascial plane blocks used as part of postoperative analgesia on postoperative pain control, opioid consumption, respiratory parameters, mechanical ventilation duration, and early oxygenation in patients undergoing open heart surgery via median sternotomy, compared with patients receiving conventional analgesic management.

Conditions

Fascial Plane Block; ICU Length of Stay; Mechanical Ventilation Duration; Cardiac Surgery; Oxygenation

Keywords

fascial plane block; cardiac surgery; mechanical ventilation; icu lenght of stay; oxygenation

Outcome Measures

Primary Outcomes (3)

• Mechanical Ventilation Duration

  Total time on mechanical ventilator support in hours.

  Up to 72 hours postoperatively

• Extubation Time

  Time from ICU admission to tracheal extubation in hours.

  Up to 48 hours postoperatively

• ICU Length of Stay

  Duration of intensive care unit stay in hours, measured from ICU admission to discharge.

  Up to 7 days postoperatively

Secondary Outcomes (4)

• PaO₂/FiO₂ Ratio

  Postoperative 6th, 12th, and 24th hours

• Postoperative Pain Score (VAS)

  Postoperative 6th, 12th, and 24th hours

• Total Opioid Consumption

  First 24 hours postoperatively

• Rescue Analgesic Requirement

  First 24 hours postoperatively

Study Arms (2)

Group 0 (Conventional Group)

group that does not have a block applied

Other: conventional analgesic regimen

Group 1 (Fascial Plane Group)

combined PIFB and SAPB group

Other: Fascial Plane Blocks

Interventions

conventional analgesic regimen OTHER

At the end of the surgery, wound site infiltration and IV paracetamol 1 g and IV tramadol 100 mg were administered for multimodal analgesia. During the follow-up period in the intensive care unit (ICU), IV paracetamol 1 g and IV tramadol 50 mg were routinely administered every 6 hours. The threshold value for rescue analgesia requirement was determined as Visual Analog Scale (VAS) ≥ 4; IV meperidine 100 mg was administered as a rescue dose to patients exceeding this threshold.

Group 0 (Conventional Group)

Fascial Plane Blocks OTHER

PIFB: Under ultrasound guidance, 15 mL of 0.25% bupivacaine is injected bilaterally into the fascial plane between the pectoralis major and external intercostal muscles, 2-3 cm lateral to the sternal border. SAPB: Under ultrasound guidance, 15 mL of 0.25% bupivacaine is injected bilaterally into the fascial plane between the serratus anterior muscle and the ribs at the 4th-5th rib level in the midaxillary line. At the end of surgery, IV paracetamol 1 g and IV tramadol 100 mg were administered. In the ICU, IV paracetamol 1 g and IV tramadol 50 mg were given every 6 hours. Rescue analgesia (IV meperidine 100 mg) was administered for VAS ≥ 4.

Group 1 (Fascial Plane Group)

Eligibility Criteria

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

Study Population

elective coronary artery bypass grafting (CABG) or heart valve surgery via sternotomy.

Sponsors & Collaborators

• Bursa City Hospital: lead

Study Sites (1)

Bursa City Hospital,

Bursa, nilüfer, Turkey (Türkiye)

Location

Related Publications (2)

• 11. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35(35):2383-2431. 12. Fitzgibbon DR, Koyyalagunta D. A practical approach to acute pain management after cardiac surgery. ASA Refresher Courses Anesthesiol. 2010;38(1):37-48. 13. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68(11):1107-1113. 14. Ueshima H, Otake H. Clinical experiences of pecto-intercostal fascial block for postoperative analgesia in cardiac surgery. J Clin Anesth. 2017;36:44-45. 15. Kaushal B, Chauhan S, Saini K, et al. Comparison of the efficacy of ultrasound-guided serratus anterior plane block, pectoral nerves II block, and local infiltration analgesia for management of postoperative pain and quality of recovery in patients undergoing modified radical mastectomy. J Clin Anesth. 2019;54:118-124. 16. Portela DA, Otero PE, Briganti A. Serratus anterior plane block in canine cadavers: anatomical evaluation. Vet Anaesth Analg. 2019;46(4):516-524. 17. Hong B, Yoon SH, Huh B, Lee S, Yoon JU, Byeon GJ. Serratus anterior plane block for refractory pain after cardiac surgery. Pain Physician. 2019;22(3):E219-E224. 18. Choudhary MK, Bhaware B, Bhui A, et al. Bilateral pecto-intercostal fascial plane block with serratus anterior plane block versus both blocks individually for post-median sternotomy analgesia: a randomized controlled trial. J Cardiothorac Vasc Anesth. 2022;36(9):3348-3356. 19. Ahmed Z, Ke J, Zhong Y, et al. Combined pecto-intercostal fascial block and serratus anterior plane block for analgesia after cardiac surgery: a retrospective cohort analysis. J Pain Res. 2023;16:1785-1794.

  BACKGROUND

• 1. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations. JAMA Surg. 2019;154(8):755-766. 2. Yildiz O, Doganci S. Cardiac surgery in Turkey: national database and current status. Turk Gogus Kalp Damar Cerrahisi Derg. 2020;28(1):1-6. 3. Muellejans B, Matthey-Doret D, Mey C, et al. Postoperative pain after cardiac surgery: a prospective cross-sectional multicentre cohort study. Eur J Anaesthesiol. 2021;38(2):134-142. 4. Thorpe SJ, Hyde R, Blackburn A. Pain management after cardiac surgery: an updated review. J Cardiothorac Vasc Anesth. 2021;35(9):2839-2851. 5. Richebe P, Capdevila X, Rivat C. Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology. 2018;129(3):590-607. 6. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215-2225. 7. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77-86. 8. Chu LF, Angst MS, Clark D. Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. Clin J Pain. 2008;24(6):479-496. 9. De Oliveira GS Jr, Agarwal D, Benzon HT. Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials. Anesth Analg. 2012;114(2):424-433. 10. Kehlet H, Dahl JB. The value of "multimodal" or "balanced analgesia" in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-1056.

  BACKGROUND

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: associate professor

Study Record Dates

• First Submitted: March 13, 2026
• First Posted: March 17, 2026
• Study Start: July 1, 2025
• Primary Completion: December 31, 2025
• Study Completion: February 28, 2026
• Last Updated: March 17, 2026

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)