A Randomized Trial Comparing Erector Spinae Plane Block Versus Serratus Posterior Superior Intercostal Plane Block for Postoperative Analgesic Efficacy in Patients Undergoing Coronary Artery Bypass Graft Surgery
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Kutahya Health Sciences University
- Enrollment
- 64
- Primary Endpoint
- Postoperative pain intensity
Overview
Brief Summary
This prospective, randomized, active-controlled, double-blind, parallel-group study compares the postoperative analgesic efficacy and safety of ultrasound-guided bilateral Erector Spinae Plane Block (ESPB) versus bilateral Serratus Posterior Superior Intercostal Plane Block (SPSIPB) in adult patients (45-85 years, ASA I-III) undergoing elective coronary artery bypass graft surgery. The primary outcome is postoperative pain intensity assessed by Numeric Rating Scale (NRS) at 2, 4, 8, 16, 24, and 48 hours after surgery. Secondary outcomes include intraoperative fentanyl/remifentanil consumption, postoperative morphine consumption, patient-controlled analgesia (PCA) demand/delivery parameters (if PCA is used), need for rescue analgesics, extubation and mobilization times, peak inspiratory flow measured by incentive spirometry at predefined time points, ICU and hospital length of stay, recovery quality (QoR-15 at 0, 24, and 48 hours), mortality, and block-related adverse events.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 45 Years to 85 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age 45-85 years
- •Scheduled for elective coronary artery bypass graft (CABG) surgery
- •American Society of Anesthesiologists (ASA) I-II-III
- •Patients who provide written informed consent and agree to participate in the study
Exclusion Criteria
- •Emergency cases
- •Known allergy to local anesthetics
- •Coagulopathy (platelet count \<100,000/mm³, INR \>1.5, aPTT \>1.5× normal)
- •Infection at the block injection site
- •Pregnancy
- •Patients who do not provide written informed consent or decline to participate after being informed
Arms & Interventions
Erector Spinae Plane Block (ESPB)
Ultrasound-guided bilateral Erector Spinae Plane Block will be performed preoperatively under sedation at the T4-T5 transverse process level. A total of 20 mL of 0.25% bupivacaine will be injected per side (total 40 mL). All participants will receive standardized general anesthesia for CABG and the same postoperative multimodal analgesia protocol.
Intervention: Ultrasound-guided Erector Spinae Plane Block (ESPB) (Procedure)
Serratus Posterior Superior Intercostal Plane Block (SPSIPB)
Ultrasound-guided bilateral Serratus Posterior Superior Intercostal Plane Block will be performed preoperatively under sedation at the 2nd-3rd intercostal space. A total of 20 mL of 0.25% bupivacaine will be injected per side (total 40 mL). All participants will receive standardized general anesthesia for CABG and the same postoperative multimodal analgesia protocol.
Intervention: Ultrasound-guided Serratus Posterior Superior Intercostal Plane Block (SPSIPB) (Procedure)
Outcomes
Primary Outcomes
Postoperative pain intensity
Time Frame: 2, 4, 8, 16, 24, and 48 hours after surgery
Pain intensity will be assessed using the Numerical Rating Scale (NRS), ranging from 0 to 10, where 0 = no pain and 10 = worst imaginable pain. Higher scores indicate worse pain.
Secondary Outcomes
- Cumulative postoperative opioid consumption(First 24 hours after surgery)
- Need for rescue analgesia(Up to 48 hours after surgery)
- Quality of Recovery (QoR-15) score(Baseline (preoperative), postoperative 24 hours, and 48 hours after surgery)
Investigators
Merve Yaman
Assistant Professor
Kutahya Health Sciences University