Parasternal vs. Combined Parasternal-Serratus Block in Cardiac Surgery (Hanedan Block)

Comparison of the Analgesic Effects of Parasternal Intercostal Plane Block Versus Combined Parasternal and Serratus Plane Block After Cardiac Surgery: A Randomized Controlled Trial

This randomized controlled trial aims to compare the analgesic efficacy of parasternal intercostal plane block (PIPB) alone versus the combination of parasternal intercostal plane block and serratus anterior plane block (SAPB) in adult patients undergoing elective cardiac surgery via sternotomy. Seventy patients will be randomly assigned to two groups: Group A will receive bilateral PIPB, while Group B will receive bilateral PIPB combined with unilateral SAPB on the side of chest drain placement. Postoperative pain will be assessed using the visual analog scale (VAS) at rest and during movement over the first 24 hours. Secondary outcomes include time to extubation, length of stay in the intensive care unit, and time to mobilization. The study is designed as a prospective, single-center, single-blind trial conducted at Akdeniz University Hospital, Antalya, Turkey. We hypothesize that the combined block technique will provide superior analgesia, reduce opioid consumption, and improve recovery parameters compared to PIPB alone

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Cardiac Surgery
• Intervention / Treatment: Procedure: Parasternal Intercostal Plane Block; Procedure: Parasternal Intercostal Plane Block + Serratus Anterior Plane Block

Detailed Description

Poststernotomy pain after cardiac surgery is a major clinical concern, often leading to impaired respiratory function, limited mobilization, and prolonged intensive care unit (ICU) stay. Although opioids are traditionally used as the mainstay of postoperative analgesia, their side effects-including respiratory depression, nausea, constipation, and delirium-limit their optimal use. Therefore, regional anesthesia techniques that reduce opioid consumption have gained increasing importance in cardiac anesthesia practice.

The parasternal intercostal plane block (PIPB) targets the anterior branches of the thoracic intercostal nerves and has been shown to provide effective analgesia around the sternotomy site. However, PIPB alone may be insufficient for controlling pain originating from lateral chest wall regions, particularly at chest drain insertion sites, which are innervated by the lateral cutaneous branches of the intercostal nerves. To address this limitation, the serratus anterior plane block (SAPB) has been proposed, as it effectively blocks the lateral thoracic dermatomes and thus may provide broader postoperative pain coverage.

This prospective, randomized, single-blind clinical trial is designed to compare the analgesic efficacy of bilateral PIPB alone versus bilateral PIPB combined with unilateral SAPB in adult patients undergoing elective cardiac surgery via sternotomy. A total of 70 patients will be randomly allocated into two groups: Group A will receive bilateral PIPB with standard intravenous morphine, while Group B will receive bilateral PIPB plus unilateral SAPB on the side of chest drain placement. Blocks will be performed under ultrasound guidance using bupivacaine at safe dose limits.

The primary outcome is postoperative pain intensity assessed by the visual analog scale (VAS) at rest and during coughing/movement within the first 24 hours. Secondary outcomes include time to extubation, ICU length of stay, and time to first mobilization. Additional endpoints are rescue opioid requirements and total analgesic consumption within the first 24 hours. We hypothesize that the combined PIPB + SAPB technique will provide superior analgesia, reduce opioid use, and enhance recovery parameters compared with PIPB alone.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Konya, Turkey (Türkiye)
    • SBÜ Konya Şehir Hastanesi

Participation Criteria

Eligibility Criteria

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

Description

• Inclusion Criteria Adult patients aged 18 years or older Patients scheduled for elective cardiac surgery Patients admitted postoperatively to the intensive care unit Patients who provide written informed consent
• Exclusion Criteria Known allergy to study medications Chronic opioid use before surgery Severe hepatic or renal failure Neurological or psychiatric disorders affecting pain assessment Inability to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Parasternal Intercostal Plane Block; Patients will receive bilateral parasternal intercostal plane block with bupivacaine under ultrasound guidance, plus standard intravenous morphine at the end of surgery.	Procedure: Parasternal Intercostal Plane Block; Bilateral parasternal intercostal plane block will be performed under ultrasound guidance at the 3rd and 5th intercostal spaces using 0.25% bupivacaine (total 30 mL). At the end of surgery, intravenous morphine (0.1 mg/kg) will be administered.; Procedure: Parasternal Intercostal Plane Block + Serratus Anterior Plane Block; Bilateral parasternal intercostal plane block will be performed as in Arm 1. In addition, a unilateral serratus anterior plane block will be performed under ultrasound guidance at the 4th-6th intercostal level on the side of chest drain placement, with 0.25% bupivacaine (5-7 mL per injection site, not exceeding 2.5 mg/kg).
Experimental: Parasternal + Serratus Plane Block; Patients will receive bilateral parasternal intercostal plane block combined with unilateral serratus anterior plane block (on the chest drain side), using bupivacaine under ultrasound guidance.	Procedure: Parasternal Intercostal Plane Block; Bilateral parasternal intercostal plane block will be performed under ultrasound guidance at the 3rd and 5th intercostal spaces using 0.25% bupivacaine (total 30 mL). At the end of surgery, intravenous morphine (0.1 mg/kg) will be administered.; Procedure: Parasternal Intercostal Plane Block + Serratus Anterior Plane Block; Bilateral parasternal intercostal plane block will be performed as in Arm 1. In addition, a unilateral serratus anterior plane block will be performed under ultrasound guidance at the 4th-6th intercostal level on the side of chest drain placement, with 0.25% bupivacaine (5-7 mL per injection site, not exceeding 2.5 mg/kg).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postoperative pain intensity (VAS)	Pain intensity measured using the Visual Analog Scale (VAS), ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain.	24 hours after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to extubation	The duration (in minutes) from the end of surgery to successful extubation.	Postoperative period until extubation.
Length of stay in the intensive care unit (ICU)	Duration of ICU stay measured from admission to the intensive care unit after surgery until transfer to the hospital ward.	From ICU admission after surgery until ICU discharge, up to 30 days
Time to first mobilization	Time from admission to the intensive care unit after surgery until the first documented patient mobilization attempt.	From ICU admission after surgery until the first mobilization attempt, assessed up to 30 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of rescue opioid administrations	Total number of rescue opioid administrations required for postoperative analgesia.	Within the first 24 hours after surgery
Total dose of rescue opioids	Total cumulative dose of rescue opioids administered for postoperative analgesia.	Within the first 24 hours after surgery

Collaborators and Investigators

• Sponsor: BEDİA MİNE HANEDAN
• Investigators: Principal Investigator: BEDİA MİNE HANEDAN, Konya şehir hastanesi

Publications and helpful links

General Publications

• Kuwano K, Kawasaki M, Maeyama T, Hagimoto N, Nakamura N, Shirakawa K, Hara N. Soluble form of fas and fas ligand in BAL fluid from patients with pulmonary fibrosis and bronchiolitis obliterans organizing pneumonia. Chest. 2000 Aug;118(2):451-8. doi: 10.1378/chest.118.2.451.
• Servidio AG, Capata G, Levantino L, Riccio G, Contorno S, Barbi E, Maschio M. COVID-19 lockdown beneficial effects on lung function in a cohort of cystic fibrosis patients. Ital J Pediatr. 2021 Jan 18;47(1):12. doi: 10.1186/s13052-021-00970-4. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): October 5, 2025
• Primary Completion (Actual): May 5, 2026
• Study Completion (Actual): May 5, 2026

Study Registration Dates

• First Submitted: September 25, 2025
• First Submitted That Met QC Criteria: April 3, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 6, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Serratus Anterior Plane Block; Parasternal Intercostal Plane Block; Cardiac Surgery Analgesia
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative
• Other Study ID Numbers: HanedanBlock-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The investigators have not yet determined whether individual participant data (IPD) will be shared. If sharing is pursued, de-identified data related to postoperative pain scores, opioid consumption, and recovery parameters may be made available to qualified researchers upon reasonable request after the main results are published.
• IPD Sharing Time Frame: 6 month
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No