Multimodal Fascial Plane Block for Postoperative Analgesia in Isolated CABG Surgery

Официальное название

Effect of Induction-Time Multimodal Fascial Plane Block on Postoperative Analgesia and Opioid Consumption in Patients Undergoing Isolated Coronary Artery Bypass Grafting: A Prospective Randomized Controlled Trial

Обзор

Postoperative pain following coronary artery bypass grafting (CABG) via median sternotomy remains a significant clinical problem and is associated with increased opioid consumption and postoperative complications. Fascial plane blocks have emerged as part of multimodal analgesia strategies in cardiac surgery. This prospective, randomized, controlled, single-blinded study aims to evaluate the effect of an induction-time multimodal fascial plane block package-consisting of bilateral superficial parasternal block, bilateral serratus anterior plane block, and adductor canal block-on postoperative analgesia, opioid consumption, and clinical outcomes in patients undergoing elective isolated CABG with saphenous vein graft harvesting. Patients will be randomized in a 1:1 ratio to receive either the multimodal fascial plane block package in addition to standard postoperative analgesia or standard postoperative analgesia alone. The primary outcome is total opioid consumption within the first 24 postoperative hours. Secondary outcomes include pain scores, time to first opioid requirement, extubation time, postoperative pulmonary complications, atrial fibrillation, and length of ICU and hospital stay.

Подробное описание

Median sternotomy, chest drains, and saphenous vein graft harvesting are major contributors to postoperative pain following CABG surgery. Inadequate pain control may impair respiratory mechanics, delay mobilization, and increase postoperative morbidity. Multimodal analgesic approaches aim to reduce opioid requirements and improve recovery profiles.

This single-center, prospective, randomized controlled trial will include adult patients (18-80 years) scheduled for elective isolated CABG with saphenous vein graft harvesting. After written informed consent, eligible participants will be randomly assigned to either the intervention group or the control group.

The intervention group will receive ultrasound-guided bilateral superficial parasternal block, bilateral serratus anterior plane block, and adductor canal block following induction of general anesthesia and prior to surgical incision. The control group will receive standard perioperative analgesia without regional block. All other perioperative management will be standardized.

The primary endpoint is total opioid consumption within the first 24 hours postoperatively. Secondary endpoints include pain scores at predefined time points (6, 12, 24, and 48 hours), time to first opioid requirement, extubation time, incidence of postoperative pulmonary complications and atrial fibrillation, ICU length of stay, hospital length of stay, and time to first mobilization.

The study is designed to assess whether a multimodal fascial plane block strategy can improve postoperative analgesia and reduce opioid use in cardiac surgery patients.

Вмешательства

• Процедура Multimodal Fascial Plane Block Package
  Participants will receive ultrasound-guided bilateral superficial parasternal block, bilateral serratus anterior plane block, and adductor canal block after induction of general anesthesia and before surgical incision.
• Другое Standard Postoperative Analgesia
  Participants will receive standard institutional perioperative and postoperative analgesia without regional fascial plane block.

Первичные конечные точки

• Total opioid consumption within the first 48 postoperative hours [Срок оценки: Through 48 hours after surgery]

Вторичные конечные точки (3)

• Postoperative pain intensity scores [Срок оценки: At 6, 12, 24, and 48 hours after surgery]
• Time to first rescue analgesic requirement [Срок оценки: Within 48 hours after surgery]
• Extubation time [Срок оценки: From ICU admission to extubation, assessed through 24 hours after surgery]

Критерии участия

Критерии включения

• Age between 18 and 80 years
• Scheduled for elective isolated coronary artery bypass grafting (CABG) with saphenous vein graft harvesting
• ASA physical status II-IV
• Ability to provide written informed consent

Критерии исключения

• Known coagulopathy or contraindication to regional anesthesia
• Use of anticoagulant therapy precluding regional block
• Known allergy to local anesthetics
• Local infection at planned block sites
• Chronic opioid use or chronic pain syndrome
• Emergency surgery
• Redo sternotomy
• Severe neurological disorder affecting pain assessment

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital — Diyarbakır

Публикации

• Kalli A, Vistbacka J, Moilanen E, Jarvela K, Mennander A. Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial. Eur J Cardiothorac Surg. 2025 Jul 1;67(7):ezaf226. doi: 10.1093/ejcts/ezaf226. PMID 40627369
• Zhang J, Luo F, Zhang X, Xue Y. Ultrasound-Guided Continuous Parasternal Intercostal Block Relieves Postoperative Pain After Open Cardiac Surgery: A Case Series. J Cardiothorac Vasc Anesth. 2022 Jul;36(7):2051-2054. doi: 10.1053/j.jvca.2021.05.028. Epub 2021 May 21. PMID 34183252
• Zengin EN, Yigit H, Cobas M, Salman N, Asli Demir Z. The analgesic effects of combined bilateral parasternal block and serratus anterior plane block for coronary artery bypass grafting surgery. BMC Anesthesiol. 2024 Aug 5;24(1):274. doi: 10.1186/s12871-024-02659-7. PMID 39103782

Идентификаторы

NCT: NCT07587320 · GY-CABG-2026

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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