RecruitingNot ApplicableNCT07164677

Serratus Posterior Superior Plane Block for Postoperative Pain in Cardiac Surgery

Efficacy of the Serratus Posterior Superior Intercostal Plane Block for Postoperative Acute Pain Management in Open-Heart Surgery

Sponsor

Ondokuz Mayıs University

Enrollment

50 participants

Start Date

Sep 13, 2025

Study Type

INTERVENTIONAL

Conditions

Cardiac Surgery Post Operative Pain, Acute

Summary

The aim of this study is to investigate the efficacy of bilateral serratus posterior superior intercostal plane (SPSIP) block on postoperative acute pain and opioid consumption in patients undergoing on-pump open-heart surgery. Postoperative outcomes including pain scores, cumulative morphine use, quality of recovery, and opioid-related side effects will be evaluated within the first 24 hours after surgery.

Eligibility

Min Age: 18 YearsMax Age: 80 Years

Inclusion Criteria4

Patients aged 18-80 undergoing elective on-pump open-heart surgery via median sternotomy.
American Society of Anesthesiologists (ASA) classification II-III patients.
Patients who can use PCA.
Patients who will sign the informed consent form.

Exclusion Criteria13

History of opioid use for more than four weeks
Chronic pain syndromes
Patients with a history of local anesthetic or opioid allergy, hypersensitivity
Alcohol and drug addiction
Conditions where regional anesthesia is contraindicated
Failure in the dermatomal examination performed after the block
Emergency surgeries and redo surgeries.
Individuals with obstructive sleep apnea.
Left ventricular ejection fraction less than 30%.
Patients with severe psychiatric illnesses (such as psychosis, dementia) that limit cooperation with verbal numerical pain scales.
Pregnant and breastfeeding patients.
Hematological disorders.
Significant impairment in the function of a major organ (e.g., severe hepatic or renal disease). • Patients who cannot be extubated within the first 6 hours postoperatively.

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Interventions

PROCEDUREBilateral ultrasound guided Serratus Posterior Superior Plane Block

Bilateral ultrasound-guided Serratus Posterior Superior Plane Block (total of 60 ml, %0.25 bupivacaine) will be performed Multimodal analgesia : Intraoperatively, all patients will receive 0.05 mg/kg (IBW) iv morphine. Thirty minutes before the end of surgery, 1 gram of intravenous paracetamol will be administered. Postoperative analgesia: iv paracetamol 1gr every 8 hours and IV PCA of 0,5mg/ml morphine. In cases where rescue analgesia is required (NRS score ≥4),iv fentanyl 25-50 mcg and/or ibuprofen and/or ketamine 10 mg will be administered. Patients are routinely administered iv dexamethasone 4 mg and IV 8 mg ondansetron 20 minutes before end of surgery for postoperative nausea and vomiting prophylaxis.

DRUGIV morphine patient-controlled analgesia

IV PCA of 0,5mg/ml morphine (the bolus dose is 20 μg/kg, the lock-in time of 6-10 minutes, the 4-hour limit is adjusted to be 80% of the calculated total amount).

PROCEDUREBilateral ultrasound guided Sham Block

Bilateral ultrasound-guided needle placement will be performed in the same anatomical plane as in the SPSIP group, but instead of local anesthetic, an equivalent volume of normal saline (30 mL per side) will be injected. Multimodal analgesia : Intraoperatively, all patients will receive 0.05 mg/kg (IBW) iv morphine. Thirty minutes before the end of surgery, 1 gram of intravenous paracetamol will be administered. Postoperative analgesia: iv paracetamol 1gr every 8 hours and IV PCA of 0,5mg/ml morphine. In cases where rescue analgesia is required (NRS score ≥4),iv fentanyl 25-50 mcg and/or ibuprofen and/or ketamine 10 mg will be administered. Patients are routinely administered iv dexamethasone 4 mg and IV 8 mg ondansetron 20 minutes before end of surgery for postoperative nausea and vomiting prophylaxis.