Efficacy of erector spinae plane block versus extrapleural catheter analgesia for postoperative pain control in minimally invasive cardiac surgery
Acute postoperative pain following minimally invasive cardiac surgery
Randomisation is performed using a computer-generated random allocation sequence with permuted blocks of variable size (4 and 8). Allocation concealment is ensured using sequentially numbered, opaque, sealed envelopes prepared according to the randomisation list. Envelopes are opened only after eligibility confirmation and written informed consent. Participants and outcome assessors are blinded to treatment allocation. Enrolled patients will be randomly assigned to either the erector spinae plane block (ESPB) group or the extrapleural catheter (EPC) group. In the ESPB group, an ultrasound-guided catheter will be inserted preoperatively in the sitting position between the transverse process of the fifth thoracic vertebra and the erector spinae muscle. In the EPC group, an extrapleural catheter will be inserted by the surgeon under direct vision immediately before wound closure. All patients will undergo standardized total intravenous anesthesia with propofol and remifentanil and left-sided double-lumen endotracheal intubation. Mechanical ventilation will be adjusted to maintain adequate oxygenation and ventilation. Surgical access will be through a left fifth intercostal incision with placement of a chest drain. In both groups, 30 mL of 0.25% bupivacaine will be administered via the catheter before skin closure, followed by continuous infusion of 0.125% bupivacaine at 3–8 mL/h. Postoperative multimodal analgesia will include intravenous paracetamol and metamizole. Rescue analgesia will be provided with hydromorphone as needed. Pain scores, opioid-related adverse events, duration of intubation, intensive care unit stay, and total hospital length of stay will be recorded.
1. Patients aged between 18 and 80 years 2. Scheduled for mini-invasive direct coronary artery bypass (MIDCAB) via thoracotomy
1. Body mass index less than 18 or greater than 30 kg/m2 2. Emergency or redo surgery 3. Contraindications to the use of regional blocks 4. Diagnosed psychiatric disorder 5. History of opioid addiction 6. With chronic or neuropathic pain 7. Patient refusal