Comparison of Sensory Analysis After Superficial and Deep Parasternal Intercostal Plane Blocks

Comparison of Maximum Extension of Sensory Assessment Following Superficial and Deep Parasternal Intercostal Plane Blocks

Postoperative pain following cardiac surgery is a common issue that can negatively impact patients' quality of life. Effective perioperative pain management is crucial to improving patient outcomes. Pain is typically most intense during the first two postoperative days, and inadequate management can lead to chronic pain, further diminishing quality of life. Recent advances in ultrasound-guided regional anesthesia, including superficial and deep parasternal intercostal plane blocks, have enhanced acute pain control. These blocks aim to provide analgesia by targeting the anterior cutaneous branches of the T2-6 thoracic nerves. While their efficacy is recognized, sensory evaluation and dermatomal analysis remain unexplored. Cadaver studies suggest that the deep block may cover more parasternal space than the superficial block.

Study Overview

• Status: Completed
• Conditions: Pain, Postoperative
• Intervention / Treatment: Other: Sensory Assessment

Detailed Description

This observational study evaluates sensory blocks in patients undergoing open-heart surgery who receive superficial or deep parasternal intercostal plane blocks. Sensory assessment, conducted by a blinded researcher 30 minutes post-block, involves applying small ice tubes with cold sensations categorized as Normal, Reduced, or No cold. A successful block is defined as the loss or reduction of cold sensitivity, while normal cold sensation indicates block failure. Assessments start at the midline, moving laterally to the anterior axillary line. Marked areas are digitally analyzed. Block regression is evaluated at 12 and 24 hours post-procedure using the same cold assessment criteria.

• Study Type: Observational
• Enrollment (Actual): 33

Contacts and Locations

Study Locations

• Turkey
  • Samsun, Turkey
    • Ondokuz Mayis University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients scheduled for median sternotomy as part of open-heart surgery and who have received either a superficial or deep parasternal intercostal plane block will be enrolled

Description

Inclusion Criteria:

• Patients who will undergo effective open heart surgery with median sternotomy
• Patients who have undergone superficial or deep parasternal intercostal plane block

Exclusion Criteria:

• Patients with severe psychiatric illnesses such as psychosis or dementia that would prevent communication with the patient
• Patients who do not want to participate in the study
• Redo surgeries
• Patients whose block is considered unsuccessful with the cold application test at the 30th minute
• Patients who cannot be extubated 12 hours post-block.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Deep Parasternal; Patients scheduled for open-heart surgery will receive a deep parasternal intercostal plane block preoperatively, and sensory block status will be evaluated 30 minutes later using small ice tubes.	Other: Sensory Assessment; Patients scheduled for open-heart surgery will receive a deep/superficial parasternal intercostal plane block preoperatively, and sensory block status will be evaluated after 30 minutes.
Superficial Parasternal; Patients scheduled for open-heart surgery will receive a superficial parasternal intercostal plane block preoperatively, and sensory block status will be evaluated 30 minutes later using small ice tubes.	Other: Sensory Assessment; Patients scheduled for open-heart surgery will receive a deep/superficial parasternal intercostal plane block preoperatively, and sensory block status will be evaluated after 30 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Extent of Sensory Blockade Measured by Cold Sensation Testing Across the Anterior Chest Wall Following Deep and Superficial Parasternal Intercostal Plane Blocks.	Participants will undergo sensory assessment using standardized cold sensation test at 30 minutes post-block to evaluate the maximum sensory blockade. The data will be recorded as the area of sensory loss (in cm) along the anterior chest wall, and the results will be aggregated to report the maximum area of sensory blockade achieved for both deep and superficial blocks. Cold sensation will be categorized as Normal Cold, Reduced Cold, or No Cold Sensation. A successful block is defined as a complete loss or reduction of cold sensitivity.	30 minutes after the blocks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Regression of Sensory Blockade at 12 and 24 Hours Post-Block	Block regression will be evaluated at 12 and 24 hours after block administration using cold sensation testing with ice tubes. The cold sensation will be categorized as Normal Cold, Reduced Cold, or No Cold Sensation. Participants who report Normal Cold sensation will be considered to have experienced block regression.	Postoperative Day 1
Opioid Consumption	Opioid consumption at 12, and 24 hours after block administration will be measured by IV patient controlled analgesia.	Postoperative Day 1
Acute pain scores	Pain status at rest and while coughing will be assessed by Numeric Rating Scale (NRS) scores at 12, and 24 hours after block administration.The NRS is an 11-point numeric scale which ranges from 0 to 10.	Postoperative Day 1

Collaborators and Investigators

• Sponsor: Ondokuz Mayıs University
• Investigators: Principal Investigator: Burhan Dost, M.D., Ondokuz Mayıs University

Study record dates

Study Major Dates

• Study Start (Actual): September 14, 2024
• Primary Completion (Actual): February 1, 2025
• Study Completion (Actual): February 27, 2025

Study Registration Dates

• First Submitted: August 13, 2024
• First Submitted That Met QC Criteria: August 15, 2024
• First Posted (Actual): August 19, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 28, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: analgesia; pain Management; sensory assessment
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pain, Postoperative
• Other Study ID Numbers: SensoryParasternal

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No