Ultrasound-Guided Parasternal/Rectus Sheath Block vs Erector Spinae Plane Block for Pain Control in Cardiac Surgery

Официальное название

Comparison of Ultrasound Guided Bilateral Parasternal Block With Bilateral Rectus Sheath Block Versus Ultrasound Guided Bilateral Erector Spinae Plane Block in Controlling Intra and Post-operative Pain After Cardiac Surgeries

Обзор

The researchers are working to improve recovery after heart surgery by reducing reliance on opioids. Newer regional anesthesia techniques can provide strong pain relief with fewer risks, but the choice of method depends on each patient's condition, medications, and surgical plan

Подробное описание

Optimal anesthesia in cardiac surgery requires careful management to avoid sympathetic stimulation, with analgesia being central to patient safety and recovery. Traditionally, high-dose opioids were used, but this approach delays extubation, conflicting with fast-track protocols that emphasize early extubation. Consequently, opioid-free analgesia has gained importance, employing regional techniques such as neuraxial, paravertebral, and fascial plane blocks.

Thoracic epidural analgesia (TEA) offers effective pain control and reduces perioperative cardiovascular and respiratory complications. However, its use in anticoagulated patients raises concern for epidural hematoma. Alternatives like paravertebral and fascial plane blocks provide comparable analgesia with lower risk. The erector spinae plane block (ESPB) reduces analgesic requirements, though deep blocks still pose bleeding risks.

Superficial plane blocks are therefore clinically valuable. The parasternal intercostal block-targeting anterior cutaneous branches of intercostal nerves-has emerged as a safe option for patients undergoing median sternotomy while on anticoagulant or antiplatelet therapy. Additionally, bilateral rectus sheath block can reduce chest tube insertion pain after cardiac surgery.

Вмешательства

• Процедура Parasternal/ Rectus sheath block
  the parasternal block will be performed parasternally at the level of fifth rib to the plane between the pectoralis major and the internal intercostal muscle. The rectus sheath block will be performed through injection in the plane posterior to the rectus abdominis muscle and anterior to the posterior rectus sheath
• Процедура Erector spinae plane block
  injection above the transverse process

Первичные конечные точки

• Numeric rating score [Срок оценки: 24 hours]

Вторичные конечные точки (4)

• postoperative opioid consumption [Срок оценки: 24 hours]
• extubation time [Срок оценки: immediate postoperative]
• first time to request analgesia [Срок оценки: 24 hours]
• peri-operative hemodynamics [Срок оценки: intraoperative and 24 hours]

Критерии участия

Критерии включения

• Both sexes,
• ASA III-IV patients
• body mass index between 20- 35 kg/m2
• adult patients above 18 years old will be included in the study

Критерии исключения

• Patients with global hypokinesia
• ejection fraction < 40%
• low platelet count
• coagulation impairment
• deformity in the vertebral column
• severe renal and hepatic impairment
• any known allergy to the drugs used

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

Двойное слепое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07692659 · ECC-2025-64

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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