Ultrasound-Guided Parasternal/Rectus Sheath Block vs Erector Spinae Plane Block for Pain Control in Cardiac Surgery

Comparison of Ultrasound Guided Bilateral Parasternal Block With Bilateral Rectus Sheath Block Versus Ultrasound Guided Bilateral Erector Spinae Plane Block in Controlling Intra and Post-operative Pain After Cardiac Surgeries

The researchers are working to improve recovery after heart surgery by reducing reliance on opioids. Newer regional anesthesia techniques can provide strong pain relief with fewer risks, but the choice of method depends on each patient's condition, medications, and surgical plan

Study Overview

• Status: Not yet recruiting
• Conditions: Perioperative Analgesia
• Intervention / Treatment: Procedure: Parasternal/ Rectus sheath block; Procedure: Erector spinae plane block

Detailed Description

Optimal anesthesia in cardiac surgery requires careful management to avoid sympathetic stimulation, with analgesia being central to patient safety and recovery. Traditionally, high-dose opioids were used, but this approach delays extubation, conflicting with fast-track protocols that emphasize early extubation. Consequently, opioid-free analgesia has gained importance, employing regional techniques such as neuraxial, paravertebral, and fascial plane blocks.

Thoracic epidural analgesia (TEA) offers effective pain control and reduces perioperative cardiovascular and respiratory complications. However, its use in anticoagulated patients raises concern for epidural hematoma. Alternatives like paravertebral and fascial plane blocks provide comparable analgesia with lower risk. The erector spinae plane block (ESPB) reduces analgesic requirements, though deep blocks still pose bleeding risks.

Superficial plane blocks are therefore clinically valuable. The parasternal intercostal block-targeting anterior cutaneous branches of intercostal nerves-has emerged as a safe option for patients undergoing median sternotomy while on anticoagulant or antiplatelet therapy. Additionally, bilateral rectus sheath block can reduce chest tube insertion pain after cardiac surgery.

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Walaa Y Elsabeeny, MD; Phone Number: 01007798466; Email: walaa.elsabeeny@nci.cu.edu.eg
• Study Contact Backup: Name: Mostafa A Ibrahim, MD; Phone Number: +966541227090; Email: MAbIbrahim@sghgroup.net

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Both sexes,
• ASA III-IV patients
• body mass index between 20- 35 kg/m2
• adult patients above 18 years old will be included in the study

Exclusion Criteria:

• Patients with global hypokinesia
• ejection fraction < 40%
• low platelet count
• coagulation impairment
• deformity in the vertebral column
• severe renal and hepatic impairment
• any known allergy to the drugs used

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Parasternal/ Rectus sheath; Patients will receive Parasternal and rectus sheath blocks; with injection of 10 ml bupivacaine 0.25% in each side after confirmation of needle position. Both parasternal and rectus heath blocks will be performed bilaterally	Procedure: Parasternal/ Rectus sheath block; the parasternal block will be performed parasternally at the level of fifth rib to the plane between the pectoralis major and the internal intercostal muscle. The rectus sheath block will be performed through injection in the plane posterior to the rectus abdominis muscle and anterior to the posterior rectus sheath
Experimental: Erector Spinae Plane Block; The patients will receive a bilateral ESPB with an injection of 20 ml of bupivacaine 0.25%.	Procedure: Erector spinae plane block; injection above the transverse process

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric rating score	postoperative pain scores using Numerical Rating Scale (NRS)	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
postoperative opioid consumption	opioid consumption in the first 24 hours postoperatively	24 hours
extubation time	time to extubate	immediate postoperative
first time to request analgesia	first time to request opioid analgesia	24 hours
peri-operative hemodynamics	incidence of hypotension, hypertension, tachycardia and bradycardia	intraoperative and 24 hours

Collaborators and Investigators

• Sponsor: National Cancer Institute, Egypt
• Collaborators: Saudi German Hospital - Madinah
• Investigators: Principal Investigator: Walaa Y Elsabeeny, MD, A Professor of Anesthesia, Critical Care and Pain Management, National Cancer Institute, Cairo University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 2, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 2, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Parasternal block; Rectus sheath block; ESPB; Analgesia
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: ECC-2025-64

Drug and device information, study documents

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