Comparison of Ultrasound-Guided Serratus Combination Plane Blocks and Local Wound Infiltration for Postoperative Analgesia Management in Minimally Invasive Cardiac Surgery (MICS)

İstanbul Yeni Yüzyıl Üniversitesi

Status: Enrolling

Conditions: Heart Surgery; Pain, Postoperative; Analgesia

Treatments: Procedure: Ultrasound-guided serratus anterior plane block and serratus-intercostal interfascial plane block with bupivacaine; Procedure: Local wound infiltration with bupivacaine

Study type: Interventional

Funder types: Other

Identifiers

NCT06968065

2024101338

Details and patient eligibility

About

This randomized, prospective, single-blinded study aims to compare the efficacy of ultrasound-guided serratus anterior plane (SAP) block combined with serratus-intercostal interfascial plane (SIP) block versus local wound infiltration (LWI) for postoperative analgesia in patients undergoing minimally invasive cardiac surgery (MICS). The primary outcome is total perioperative and postoperative opioid consumption. Secondary outcomes include postoperative pain scores (NRS), opioid-related side effects, block-related complications, and ICU stay duration.

Full description

Minimally invasive cardiac surgery (MICS) has gained popularity due to reduced surgical trauma and faster recovery. However, postoperative pain management remains a challenge. This study evaluates the analgesic effectiveness of combining two interfascial plane blocks-SAP and SIP-under ultrasound guidance, compared to traditional local wound infiltration. A total of 60 patients scheduled for MICS with cardiopulmonary bypass will be randomized into two groups (SAP+SIP vs LWI). Pain scores, opioid usage, and complications will be recorded at predetermined intervals up to 72 hours postoperatively.

Enrollment: 60 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18-75 years
• Undergoing MICS with left-sided 4th-5th intercostal incision
• ASA I-III
• Informed consent provided

Exclusion criteria

• Coagulopathy or on anticoagulants

  • Allergy to local anesthetics or opioids
  • Local infection at block site
  • Pregnancy or lactation
  • Bilateral thoracic incisions
  • Refusal to participate

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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60 participants in 2 patient groups

SAP + SIP Block Group

Experimental group

Description:

Participants in this arm will receive a combination of ultrasound-guided serratus anterior plane (SAP) block and serratus-intercostal interfascial plane (SIP) block. The SAP block will be performed using 30 mL of 0.25% bupivacaine, and the SIP block will use 10 mL of 0.25% bupivacaine. Both blocks will be administered after surgery but before emergence from anesthesia.

Treatment:

Procedure: Ultrasound-guided serratus anterior plane block and serratus-intercostal interfascial plane block with bupivacaine

Local Wound Infiltration Group

Active Comparator group

Description:

Participants in this arm will receive local wound infiltration (LWI) consisting of 40 mL of 0.25% bupivacaine. The infiltration will be applied to the surgical and drain sites after surgery.

Treatment:

Procedure: Local wound infiltration with bupivacaine