Comparison of Analgesic Efficacy Between Ultrasound Guided Serratus Anterior Plane Block or Thoracic Paravertebral Block Versus Intravenous Fentanyl for On-pump Coronary Artery Bypass Graft Surgery

November 2, 2026 updated by: Ain Shams University

Comparison of Analgesic Efficacy Between Ultrasound Guided Serratus Anterior Plane Block or Thoracic Paravertebral Block Versus Intravenous Fentanyl for On-pump Coronary Artery Bypass Graft Surgery: A Prospective, Randomised, Controlled Clinical Study

Aim is to compare intra and postoperative analgesic efficacy of US-guided serratus anterior plane block (SAPB) or thoracic paravertebral block (TPVB) versus intravenous fentanyl in patient undergoing on-pump CABG surgery.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Aim is to compare intra and postoperative analgesic efficacy of US-guided serratus anterior plane block (SAPB) or thoracic paravertebral block (TPVB) versus intravenous fentanyl in patient undergoing on-pump CABG surgery.

The enrolled (111) patients will be randomly assigned via a computer-generated randomization table into three parallel and equivalent (1:1:1 ratio) groups: group A (37); will receive serratus anterior plane block, group B (37);will receive thoracic paravertebral block and group C (37); standard of care control group, will receive fentanyl infusion.

Group (A):

SAPB block will be performed Bilaterally. 20 ml of 0.25% bupivacaine hydrochloride [Maracine prepared by adding an equal volume (1:1) of normal saline (0.9%) to 0.5% bupivacaine]will be injected.

Group (B):

TPVB will be performed bilaterally. 20 ml of 0.25% bupivacaine [Maracine prepared by adding an equal volume (1:1) of normal saline (0.9%) to 0.5% bupivacaine] will be injected.

Group (C) (Control):

Patient will receive IV fentanyl infusion just before skin incision, which will be stopped when cardiopulmonary bypass (CPB) is on, then resumed after weaning form CPB and continued till the end of the surgery.500µg fentanyl will be mixed with 50 ml 0.9% normal saline in 50 ml syringe (10 µg /ml).Infusion rate will be determined according to a dose of 1µg /kg/h.

Study Type

Interventional

Enrollment (Estimated)

111

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
    • Abbassia
      • Cairo, Abbassia, Egypt, 00202
        • Ain Shams University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

40 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Age: 40-70 years.
  2. Sex: Males and Females.
  3. American Society of Anaesthesiologists (ASA) Physical Status Class III.
  4. Scheduled for elective on-pump isolated CABG via median sternotomy for 1 or 2 coronary vessel grafts.
  5. Good left ventricular systolic function with ejection fraction (EF) >50%

Exclusion Criteria:

  1. Declining to give a written informed consent.
  2. History of allergy to the medications used in the study.
  3. Contraindications to regional anaesthesia as patient refusal, coagulopathy [activated partial thromboplastin time ≥45 sec, prothrombin time (INR) 1.5, platelets ≤ 80,000/dl], clopidogrel within the last 7 days of the procedure, severe spinal deformity or infection at puncture site).
  4. Psychiatric disorders or significant cognitive dysfunction.
  5. American Society of Anaesthesiologists (ASA) Physical Status Class IV or higher.
  6. Chronic use of opioids.
  7. Morbid obesity (BMI > 40 kg/m2).
  8. Patient with severe pulmonary disease.
  9. Patient who requires emergency CABG operation or redo cardiac surgery.
  10. Post operative intra-aortic balloon or extracorporeal membrane oxygenation (ECMO).
  11. Patient who will be operated for bleeding, tamponade or any reason for revision postoperatively.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: serratus anterior plane block

this group will be given 20 ml of 0.25% bupivacaine hydrochloride bilaterally
Procedure: Serratus Anterior Plane Block (SAPB) group

In SAPB; the needle is advanced in-plane from caudally cephalad at the midaxillary line at the level of the fourth rib with 45-degree angle, targeting the plane between the latissimus dorsi and serratus muscles. SAPB block will be performed Bilaterally. After confirmation that the needle tip is in the correct plane by injecting 2 ml of saline, 20 ml of 0.25% bupivacaine hydrochloride [Maracine prepared by adding an equal volume (1:1) of normal saline (0.9%) to 0.5% bupivacaine]will be injected, with intermittent aspiration to confirm neither air nor blood in the needle.
Active Comparator: thoracic paravertebral block

this group will be given 20 ml of 0.25% bupivacaine hydrochloride bilaterally
Procedure: Thoracic paravertebral block (TPVB)

In TPVB; the needle is advanced in parasagittal plane over the transverse processes of the T4 and T5 vertebrae, about 2.5 cm lateral to the spinous processes, just deep to the superior costotransverse ligament but superficial to the parietal pleura. TPVB will be performed bilaterally. After confirmation that the needle tip is in the correct plane by injecting 2 ml of saline, 20 ml of 0.25% bupivacaine [Maracine prepared by adding an equal volume (1:1) of normal saline (0.9%) to 0.5% bupivacaine] will be injected, with intermittent aspiration to confirm no air or blood in the needle.
Other: control

Intravenous fentanyl infusion 1µg /kg/h
Drug: Intravenous fentanyl 1 μg∙kg-1

Patient will receive IV fentanyl infusion just before skin incision, which will be stopped when cardiopulmonary bypass (CPB) is on, then resumed after weaning form CPB and continued till the end of the surgery.500µg fentanyl will be mixed with 50 ml 0.9% normal saline in 50 ml syringe (10 µg /ml).Infusion rate will be determined according to a dose of 1µg /kg/h.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Duration of analgesia in hours
Time Frame: up to 12 hours
up to 12 hours
Postoperative visual analogue pain score (VAS)
Time Frame: up to 12 hours

Postoperative visual analogue pain score (VAS): It will be recorded every 1 hour after admission to ICU for the first 4 hours ' then every 2 hours for the remaining 8 hours
up to 12 hours
Total dose of fentanyl
Time Frame: up to 18 hours

Total doses of intra , postoperative fentanyl consumption and doses of rescue fentanyl.
up to 18 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Intra and postoperative haemodynamic data
Time Frame: up to 18 hours

Mean blood pressure (mmHg): Baseline, immediately after performing the block, at 30 minutes intervals (except when the patient on CPB) till the end of surgery Mean blood pressure (mmHg): Immediately after ICU admission, at 1 hour intervals in the 1st 6 hours, then at 2 hours intervals till 12 hours
up to 18 hours
Postoperative extubation time
Time Frame: for 12 hours

Postoperative extubation time in minutes.
for 12 hours
Patients with block-related side effects and complications
Time Frame: for 3 days

bleeding , hematoma , inflammation , nerve injury , hemodynamic changes
for 3 days
Pulmonary function assessment
Time Frame: for 12 hours

Pulmonary function assessment [forced expiratory volume at one second as % of predicted) using spirometry: Every 6 hours after extubation up to 12 hours
for 12 hours
Intra and postoperative haemodynamic data. Heart rate
Time Frame: up to 18 hours

Heart rate (beats/minute): Baseline, immediately after performing the block, at 30 minutes intervals (except when the patient on CPB) till the end of surgery Heart rate (beats/minute): Immediately after ICU admission, at 1 hour intervals in the 1st 6 hours, then at 2 hours intervals till 12 hours
up to 18 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Ain Shams University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2026

Primary Completion (Estimated)

November 30, 2026

Study Completion (Estimated)

December 30, 2026

Study Registration Dates

First Submitted

October 14, 2026

First Submitted That Met QC Criteria

November 2, 2026

First Posted (Actual)

November 3, 2026

Study Record Updates

Last Update Posted (Actual)

November 3, 2026

Last Update Submitted That Met QC Criteria

November 2, 2026

Last Verified

October 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FMASU MD381/2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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