Serratus posterior superior intercostal plane block for pain control after minimally invasive heart bypass

Multimodal Analgesia in Minimally Invasive Cardiac Surgery: A Randomized Controlled Study on the Effectiveness of the Serratus Posterior Superior Intercostal Plane Block

We will test whether adding a serratus posterior superior intercostal plane block reduces opioid use and pain for adults (ASA III) having minimally invasive coronary artery bypass.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Kartal Kosuyolu High Speciality Training and Research Hospital (Government)
• Locations: 1 site (Istanbul)
• Trial ID: NCT07420712 on ClinicalTrials.gov

What this trial studies

This is a prospective, randomized controlled trial in 60 adult patients with ASA physical status III undergoing elective minimally invasive coronary artery bypass. Participants are randomly assigned to receive an ultrasound-guided serratus posterior superior intercostal plane block with bupivacaine in addition to standardized general anesthesia and postoperative patient-controlled analgesia, or to a control group receiving standard analgesic management without a plane block. The primary outcome is postoperative tramadol consumption, and secondary outcomes include intraoperative remifentanil use, numeric rating pain scores at rest and on coughing, time to first rescue analgesia, time to extubation, and lengths of ICU and hospital stay. Pain will be measured at predefined postoperative intervals and all procedures are performed at a single specialized center.

Who should consider this trial

Good fit: Adults aged 18 or older with ASA physical status III scheduled for elective minimally invasive coronary artery bypass who can give informed consent and meet criteria (BMI ≤35 kg/m², weight ≥42 kg, and normal coagulation) are ideal candidates.

Not a fit: Patients under 18, those with ASA status other than III, emergency surgery, BMI >35 kg/m², weight <42 kg, coagulation disorders, local infection at the injection site, or known allergy to local anesthetics are excluded and unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, adding the SPSIPB could lower postoperative opioid needs and pain, and may speed recovery with shorter ICU and hospital stays.

How similar studies have performed: Other thoracic plane blocks (such as serratus anterior and paravertebral blocks) have reduced postoperative pain and opioid use in thoracic surgery, but the serratus posterior superior intercostal plane block is a newer, less-studied variant.

Eligibility criteria

Inclusion Criteria:

* Adults aged 18 years or older
* American Society of Anesthesiologists (ASA) physical status III
* Scheduled for elective minimally invasive coronary artery bypass surgery
* Ability to understand the study procedures and provide written informed consent

Exclusion Criteria:

* Age under 18 years
* ASA physical status other than III
* Pregnancy
* Emergency surgery
* History of trauma within the previous 24 hours
* Neurological disorders affecting consciousness or decision-making capacity
* Psychiatric disorders affecting decision-making capacity or cooperation
* Known allergy to local anesthetic agents
* Infection or skin disease at the block injection site
* Body mass index greater than 35 kg/m²
* Body weight less than 42 kg
* Coagulation disorders (international normalized ratio \>1.25, activated partial thromboplastin time \>35 seconds, or platelet count \<100,000/µL)

Where this trial is running

Istanbul

• Kosuyolu High Specialization Training and Research Hospital — Istanbul, Turkey (Türkiye) (Recruiting)

Study contacts

• Principal investigator: Mustafa Burgaç, himself — [e-mail]
• Study coordinator: Mustafa Burgaç, himself

Conditions Analgesia; Serratus posterior superior intercostal plane block; Postoperative pain