Postoperative Analgesia and Ventilation After Cardiac Surgery

Summary

Cardiac surgery performed via median sternotomy is associated with significant postoperative pain due to extensive tissue trauma, sternal bone healing, and mediastinal retraction. Inadequately controlled postoperative pain represents an important source of morbidity in these patients and may adversely affect respiratory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. These complications can delay extubation, prolong the duration of mechanical ventilation, and increase the length of stay in the intensive care unit (ICU). In addition, insufficient pain control may trigger sympathetic activation, resulting in increased myocardial oxygen consumption, a higher risk of arrhythmias, and impaired immune function. Traditionally, systemic opioids have been the cornerstone of postoperative pain management in cardiac surgery; however, opioid-based analgesia is associated with several adverse effects, including respiratory depression, sedation, nausea and vomiting, gastrointestinal dysfunction, and prolonged mechanical ventilation. These limitations have led to increasing interest in multimodal analgesia strategies aimed at improving postoperative pain control while reducing opioid consumption and related complications. In this context, regional analgesia techniques have emerged as important components of multimodal pain management protocols in cardiac surgery.

The aim of this study was to evaluate the effects of fascial plane blocks used as part of postoperative analgesia on postoperative pain control, opioid consumption, respiratory parameters, mechanical ventilation duration, and early oxygenation in patients undergoing open heart surgery via median sternotomy, compared with patients receiving conventional analgesic management.

Conditions

• ICU Length of Stay
• Fascial Plane Block
• Mechanical Ventilation Duration
• Oxygenation
• Cardiac Surgery

Interventions

OTHER

conventional analgesic regimen

At the end of the surgery, wound site infiltration and IV paracetamol 1 g and IV tramadol 100 mg were administered for multimodal analgesia. During the follow-up period in the intensive care unit (ICU), IV paracetamol 1 g and IV tramadol 50 mg were routinely administered every 6 hours. The threshold value for rescue analgesia requirement was determined as Visual Analog Scale (VAS) ≥ 4; IV meperidine 100 mg was administered as a rescue dose to patients exceeding this threshold.

OTHER

Fascial Plane Blocks

PIFB: Under ultrasound guidance, 15 mL of 0.25% bupivacaine is injected bilaterally into the fascial plane between the pectoralis major and external intercostal muscles, 2-3 cm lateral to the sternal border. SAPB: Under ultrasound guidance, 15 mL of 0.25% bupivacaine is injected bilaterally into the fascial plane between the serratus anterior muscle and the ribs at the 4th-5th rib level in the midaxillary line. At the end of surgery, IV paracetamol 1 g and IV tramadol 100 mg were administered. In the ICU, IV paracetamol 1 g and IV tramadol 50 mg were given every 6 hours. Rescue analgesia (IV meperidine 100 mg) was administered for VAS ≥ 4.

Sponsors & Collaborators

• Bursa City Hospital

  lead OTHER_GOV

Eligibility

Min Age

18 Years

Max Age

85 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-07-01

Primary Completion

2025-12-31

Completion

2026-02-28

Countries

• Turkey (Türkiye)

Study Locations