Comparative Efficacy of Regional Blocks within a Transitional Pain Service Model: TTPB with SAPB versus TTPB with Intercostal Nerve Block for Post-Sternotomy and Intercostal drain Pain – A Randomized Controlled Trial

This study is a prospective, randomized, active-controlled, parallel-group interventional trial designed to evaluate the comparative efficacy of regional anesthesia techniques within a transitional pain service model for patients undergoing median sternotomy with intercostal drain placement. Patients will be randomized to receive either transversus thoracic plane block (TTPB) combined with serratus anterior plane block (SAPB) or TTPB combined with intercostal nerve block (ICNB).

The primary outcome is postoperative pain intensity (Numeric Rating Scale, at rest and on coughing) over the first 24 hours after surgery. Secondary outcomes include cumulative opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting, block-related complications, patient satisfaction, and length of ICU/hospital stay. Pain scores and analgesic requirements will be assessed at multiple time points up to 48 hours postoperatively, with follow-up at 7 and 30 days for safety and persistent pain assessment.

The trial aims to determine which block combination provides superior analgesia and enhanced recovery, potentially guiding best practices in post-sternotomy pain management within a structured transitional pain service model.