This prospective, randomized, active-controlled, double-blind, parallel-group study compares the postoperative analgesic efficacy and safety of ultrasound-guided bilateral Erector Spinae Plane Block (ESPB) versus bilateral Serratus Posterior Superior Intercostal Plane Block (SPSIPB) in adult patients (45-85 years, ASA I-III) undergoing elective coronary artery bypass graft surgery. The primary outcome is postoperative pain intensity assessed by Numeric Rating Scale (NRS) at 2, 4, 8, 16, 24, and 48 hours after surgery. Secondary outcomes include intraoperative fentanyl/remifentanil consumption, postoperative morphine consumption, patient-controlled analgesia (PCA) demand/delivery parameters (if PCA is used), need for rescue analgesics, extubation and mobilization times, peak inspiratory flow measured by incentive spirometry at predefined time points, ICU and hospital length of stay, recovery quality (QoR-15 at 0, 24, and 48 hours), mortality, and block-related adverse events.
Age 45-85 years
Scheduled for elective coronary artery bypass graft (CABG) surgery
American Society of Anesthesiologists (ASA) I-II-III
Patients who provide written informed consent and agree to participate in the study
Emergency cases
ASA IV-V
Known allergy to local anesthetics
Coagulopathy (platelet count <100,000/mm³, INR >1.5, aPTT >1.5× normal)
Parallel
Ultrasound-guided Erector Spinae Plane Block (ESPB)
Procedure/SurgeryBilateral ultrasound-guided ESPB performed preoperatively under sedation at the T4-T5 transverse process level using 20 mL of 0.25% bupivacaine per side (total 40 mL).
Ultrasound-guided Serratus Posterior Superior Intercostal Plane Block (SPSIPB)
Procedure/SurgeryBilateral ultrasound-guided SPSIPB performed preoperatively under sedation at the 2nd-3rd intercostal space using 20 mL of 0.25% bupivacaine per side (total 40 mL).
Postoperative pain intensity
Pain intensity will be assessed using the Numerical Rating Scale (NRS), ranging from 0 to 10, where 0 = no pain and 10 = worst imaginable pain. Higher scores indicate worse pain.
Cumulative postoperative opioid consumption
Total opioid dose for analgesia converted to IV morphine equivalents.
Need for rescue analgesia
Proportion of participants requiring rescue analgesics in addition to the standardized protocol.
Quality of Recovery (QoR-15) score
"The Quality of Recovery-15 questionnaire (QoR-15) is a patient-reported measure consisting of 15 items. Each item is scored from 0 (unfavourable) to 10 (favourable), resulting in a total score ranging from 0 to 150. Higher total scores indicate better postoperative recovery.
Click on the lead sponsor to view all of their trials.
