Combination of Serratus Anterior and Deep Parasternal Intercostal Plane Blocks versus Erector Spinae Plane Block for Acute Pain Management After Cardiac Surgery: A Randomized Controlled Trial

Objective: To evaluate the analgesic efficacy of bilateral erector spinae plane block (ESPB) versus the combination of deep parasternal intercostal plane block (DPIPB) and serratus anterior plane block (SAPB) for managing acute pain after cardiac surgery. Design: Prospective, randomized, assessor-blinded controlled trial Setting: A single institution, an academic university hospital Participants: Sixty patients scheduled for elective on-pump cardiac surgery through median sternotomy Interventions: Patients were allocated at random into 2 groups: bilateral ESPB (n = 30) and combined DPIPB and SAPB (n = 30). Measurements and Main Results: The primary outcome was postoperative opioid consumption over the first 24 hours. Secondary outcomes included pain scores at rest and during coughing, rescue analgesia requirements, and opioid-related adverse effects. Cumulative opioid consumption was significantly lower in the ESPB group compared to the DPIPB+SAPB group (mean, 330.00 ± 206.82 µg v 464.17 ± 232.74 µg; p = 0.022). No significant differences were observed in pain scores at the sternotomy or drain sites at rest or during coughing at any time point (p > 0.05). Additionally, there were no significant differences in rescue analgesic requirements or opioid-related side effects between the 2 groups (p > 0.05). Conclusions: In patients undergoing open-heart surgery through median sternotomy, bilateral ESPB provided more effective opioid-sparing analgesia compared to the combined DPIPB+SAPB technique, despite similar subjective pain scores and side effect profiles. These findings support the broader dermatomal spread and prolonged efficacy of ESPB, although both techniques appear to be clinically effective as components of multimodal analgesia strategies.