ASPB-PIPB Combination in Cardiac Surgery

NCT07716943 | Not Yet Recruiting

• 1 other identifier: 1025
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Cardiopulmonary bypass surgery is associated with significant postoperative pain, which may adversely affect respiratory function, delay mobilization, prolong hospital stay, and increase postoperative complications. Within Enhanced Recovery After Surgery (ERAS) protocols, multimodal analgesia and opioid-sparing strategies have become essential components of perioperative care. Ultrasound-guided fascial plane blocks, including the anterior serratus plane block (ASPB) and pectoral-intercostal plane block (PIPB), have emerged as effective and safe regional anesthesia techniques for cardiac surgery, targeting different sensory innervation of the thoracic wall. However, evidence regarding the combined use of these two blocks remains limited. This study aimed to evaluate whether the combination of ASPB and PIPB improves intraoperative and postoperative analgesia, reduces opioid consumption, and enhances postoperative recovery and ERAS outcomes compared with standard analgesic management in patients undergoing cardiopulmonary bypass surgery.

Conditions

Postoperative Pain; Cardiac Surgery; Cardiopulmonary Bypass; Median Sternotomy

Keywords

Cardiopulmonary Bypass; Postoperative Pain; Regional Anesthesia; Enhanced Recovery After Surgery

Outcome Measures

Primary Outcomes (1)

• Postoperative pain intensity

  Postoperative pain intensity will be assessed at rest and during coughing using the Visual Analog Scale at extubation (0 hour) and at 4, 8, 12, and 24 hours after surgery. The Visual Analog Scale ranges from 0 to 10 cm, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity and therefore a worse outcome.

  At extubation (0 hour) and at 4, 8, 12, and 24 hours after surgery.

Secondary Outcomes (10)

• Intraoperative fentanyl consumption

  From induction of anesthesia until the end of surgery.

• Postoperative tramadol consumption

  During the first 24 hours after surgery.

• Time to extubation

  From the end of surgery until extubation, assessed up to 7 days after surgery.

• Intensive care unit length of stay

  From postoperative intensive care unit admission until intensive care unit discharge, assessed up to 30 days after surgery.

• Hospital length of stay

  From the date of surgery until hospital discharge, assessed up to 30 days after surgery.

Study Arms (2)

GroupASPB + PIPB Group

EXPERIMENTAL

Patients in this group received ultrasound-guided bilateral anterior serratus plane block combined with bilateral pectoral-intercostal plane block after induction of general anesthesia and before surgical incision as part of the multimodal analgesia protocol.

Procedure: Combined ASPB and PIPB

ASPB Group:

ACTIVE COMPARATOR

Patients assigned to the ASPB group underwent ultrasound-guided bilateral anterior serratus plane block following induction of general anesthesia and prior to skin incision. The block was incorporated into the perioperative multimodal analgesia protocol.

Procedure: Anterior Serratus Plane Block

Interventions

Combined ASPB and PIPB PROCEDURE

Ultrasound-guided bilateral anterior serratus plane block combined with bilateral pectoral-intercostal plane block performed after induction of general anesthesia and before surgical incision to provide perioperative multimodal analgesia in patients undergoing cardiopulmonary bypass surgery.

GroupASPB + PIPB Group

Anterior Serratus Plane Block PROCEDURE

Ultrasound-guided bilateral anterior serratus plane block performed after induction of general anesthesia and before surgical incision to provide perioperative analgesia in patients undergoing cardiopulmonary bypass surgery.

ASPB Group:

Eligibility Criteria

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

You may qualify if:

• Patients undergoing open heart surgery via median sternotomy by the Cardiovascular Surgery Clinic
• Patients over 18 years of age
• ASA II-III patients

You may not qualify if:

• \- Patients undergoing emergency or recurrent surgery
• Patients with left ventricular ejection fraction \< 30
• Patients who died per-operatively
• Patients who do not provide informed consent
• Presence of chronic pain
• Presence of allergy to local anesthetics
• Presence of infection in the area where the block will be performed
• Coagulopathy
• Pre-existing neurological deficit
• Mental retardation
• Anatomical deformity

Sponsors & Collaborators

• Sisli Hamidiye Etfal Training and Research Hospital: lead

Study Sites (1)

Sisli etfal research and training hospital

Istanbul, 34371, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Pain, Postoperative

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Pain; Neurologic Manifestations; Signs and Symptoms

Study Officials

• LEYLA KILINC

  şişli etfal eğitim araştırma hastanesi

  STUDY CHAIR

Central Study Contacts

MUSTAFA ALTINAY

CONTACT

05333914422; m_altinay@yahoo.com

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: associate professor

Study Record Dates

• First Submitted: June 28, 2026
• First Posted: July 21, 2026
• Study Start: July 1, 2026
• Primary Completion (Estimated): May 30, 2027
• Study Completion (Estimated): June 30, 2027
• Last Updated: July 21, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)