ESPB vs.Combination of ESPB and Superficial PIPB in Cardiac Surgery
Condition: Anesthesia; Analgesia; Acute Pain; Patient Controlled Analgesia
MeSH terms: Acute Pain
Study type: Interventional

Summary: 
      Cardiac surgery is associated with significant postoperative pain. Pain control is an
      essential part of enhanced recovery protocols. The aim of this study is to evaluate and
      compare the analgesic efficacies of erector spinae plane block (ESPB) and the combination of
      ESPB and superficial parasternal intercostal plane block (PIPB) in patients undergoing
      elective cardiac surgery.
    

Detailed description: 
      Many regional techniques have been used to manage postoperative pain in cardiac surgery,
      including thoracic epidural anesthesia, paravertebral, intercostal nerve block, intrathecal
      spinal morphine, and local infiltration. Increased risk of epidural/spinal hematoma secondary
      to systemic heparinization, potential hemodynamic instability, technical difficulties and
      complications such as pneumothorax are potential serious drawbacks. Due to the aforementioned
      reasons, anesthetists are understandably preferring ultrasound (US) guided interfascial plane
      blocks, which are generally thought to provide safer and more effective analgesia in cardiac
      surgery.

      This study aims to evaluate and compare the effects of ESPB versus ESPB plus Superficial PIPB
      on pain scores and opioid consumption in patients undergoing elective cardiac surgery.

      Patients will be divided into two groups:

      Group ESPB:

      In this group, patients will be administered bilateral ESPB (total of 40 ml, %0.25
      bupivacaine) in addition to IV morphine patient-controlled analgesia (PCA) for the first 24
      postoperative hours.

      Group ESPB+Superficial PIPB:

      In this group, patients will be administered Bilateral ESPB (total of 40 ml, %0.25
      bupivacaine) and bilateral Superficial PIPB (total of 20 ml, %0.25 bupivacaine). In addition,
      IV morphine PCA will be administered for the first 24 postoperative hours.
    

Intervention name(s): Bilateral ultrasound-guided ESPB; Bilateral ultrasound-guided ESPB and superficial PIPB
Intervention type(s): Procedure; Procedure
Intervention description(s): Bilateral ultrasound-guided ESPB (total of 40 ml, 0.25% bupivacaine) will be performed.
Intraoperative analgesia:
At the end of the surgery, all patients will be given 0.05 mg/kg morphine IV. Postoperative analgesia: Paracetamol 1 gr IV (every 6 hours) and IV PCA of 0.5 mg/ml morphine (demand dose 20μg/kg; lock out interval 6-10 min.; the 4-hour limit will be 80% of the total calculated dose). In cases where rescue analgesia is required (NRS score ≥4) tramadol 100 mg IV will be infused within 30 minutes (max. 300 mg / day). For postoperative nausea and vomiting prophylaxis, patients will be routinely administered ondansetron 4 mg IV 20 minutes before extubation, in the intensive care unit.; Bilateral ultrasound-guided ESPB (total of 40 ml, %0.25 bupivacaine) and Superficial PIPB (total of 20 ml, %0.25 bupivacaine) will be performed.
Intraoperative analgesia:
At the end of the surgery, all patients will be given 0.05 mg/kg morphine IV. Postoperative analgesia: Paracetamol 1 gr IV (every 6 hours) and IV PCA of 0.5 mg/ml morphine (demand dose 20μg/kg; lock out interval 6-10 min.; the 4-hour limit will be 80% of the total calculated dose). In cases where rescue analgesia is required (NRS score ≥4) tramadol 100 mg IV will be infused within 30 minutes (max. 300 mg / day). For postoperative nausea and vomiting prophylaxis, patients will be routinely administered ondansetron 4 mg IV 20 minutes before extubation, in the intensive care unit.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A block randomization list will be created by a doctor who does not participate in patient follow-up using a web-based program, 'Research Randomizer (Urbaniak and Plous 2013)'.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Regional Anesthesia; Acute Pain Scores; Morphine Consumption