Fascial Plane Blocks and Quality of Recovery in Cardiac Surgery

Sponsor
Ordu University
Study ID
NCT07557108
Status
Recruiting
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Conditions

  • Cardiovascular Diseases
  • Cardiovascular Surgical Procedures
  • Pain, Postoperative

Eligibility Criteria

Sex
ALL
Age
18 Years - 70 Years
Healthy Volunteers
Not accepted

Interventions

  • Ultrasound-Guided Pectointercostal Fascial Plane Block — PROCEDURE
    Following anesthesia induction, bilateral pectointercostal fascial plane block (PIFB) will be performed under steril conditions using a high-frequency linear US probe positioned parallel to the parasternal region. The second and fourth ribs will be identified in the parasternal region under US guidance. A 100-mm echogenic peripheral nerve block needle will be advanced craniocaudally toward the fourth rib using an in-plane technique to reach the fascial plane between the pectoralis major and intercostal muscles. After confirming the target plane via hydrodissection, 20 mL of 0.25% bupivacaine will be injected into the fascial plane on each side (total 40 mL). The success of the block will be confirmed by sliding the US probe craniocaudally to directly visualize the local anesthetic spread between the pectoralis major fascia and the intercostal muscles (extending from the first to the sixth rib).
  • Ultrasound-Guided Rectus Sheath Block — PROCEDURE
    Bilateral rectus sheath block (RSB) will be performed at the end of surgery. A high-frequency linear US probe will be positioned in the epigastric region, 2-3 cm below the xiphoid process and immediately below the chest tubes, intersecting the linea alba perpendicularly. After identifying the anatomical structures (anterior rectus abdominis sheath, muscle, posterior sheath, and peritoneum) with the US probe, a 100-mm echogenic peripheral block needle will be advanced into the plane between the rectus abdominis muscle and the posterior sheath using an in-plane technique. After confirming the needle tip location via hydrodissection, a total of 20 mL of 0.25% bupivacaine (10 mL per side) will be injected into the fascial plane. Block success will be confirmed by direct visualization of the "double V"-shaped echogenic pattern formed by the spread of the local anesthetic between the fascial planes.
  • Ultrasound-Guided Recto-Intercostal Fascial Plane Block — PROCEDURE
    Bilateral recto-intercostal fascial plane block (RIFB) will be performed at the end of surgery. A high-frequency linear US probe will be positioned in the sagittal plane, 3-4 cm lateral and 3-4 cm caudal to the xiphoid process. After identifying the sixth and seventh costal cartilages and the rectus abdominis muscle, a 100-mm echogenic peripheral block needle will be advanced caudo-cranially using an in-plane technique to reach the plane between the rectus abdominis muscle and the costal cartilage. After confirming the needle tip location via hydrodissection, a total of 20 mL of 0.25% bupivacaine (10 mL per side) will be injected into the fascial plane. Block success will be confirmed by direct visualization of the local anesthetic spread in a cranio-caudal direction.

Study Details

In this randomized trial, the investigators will test the hypothesis that combining regional analgesia techniques-which have the potential to improve the quality of postoperative recovery following median sternotomy-with PIFB will accelerate recovery. Additionally, it is anticipated that RIFB, an alternative fascial plane block, will demonstrate non-inferior (at least as effective as) performance compared to RSB, thereby providing flexibility and ease of application in clinical practice.

Key Dates

First listed
Apr 29, 2026
Start date
Apr 5, 2026
Status verified
Apr 2026
Primary completion
Dec 5, 2026
Completion
Dec 20, 2026

Study Design

Enrollment
123 participants (estimated)

Arms

  • Arm: Group P
    Bilateral pectointercostal fascial plane block (PIFB) will be administered.
  • Arm: Group PRS
    Bilateral rectus sheath block (RSB) will be administered in addition to bilateral PIFB.
  • Arm: Group PRI
    Bilateral retro-intercostal fascial plane block (RIFB) will be administered in addition to bilateral PIFB.

Primary Outcome Measure

Turkish version of the Quality of Recovery-15 scale (QoR-15T) [ Time Frame: In the postoperative period, the time of extubation will be considered "postoperative hour 0". The primary endpoint is the quality of early recovery, assessed at 24 hours postoperatively. ]

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