Hybrid Parasternal Intercostal Plane Block Versus No Block for Postoperative Analgesia After Cardiac Surgery Via Median Sternotomy

Ki vehet részt

• Adults aged 19 years or older
• Scheduled for elective cardiac surgery (e.g., valve surgery, coronary artery bypass grafting) via median sternotomy under general anesthesia
• Voluntarily provided written informed consent

Ki nem vehet részt

• Emergency surgery or redo sternotomy
• Active infection, including sepsis
• Allergy to local anesthetics
• Cognitive impairment, delirium, inability to communicate, or inability to rate pain on the NRS
• Severe hepatic failure (Child-Pugh C) or end-stage renal disease on renal replacement therapy
• Any other condition the investigator judges to make participation inappropriate
• Contraindications to chest wall nerve block, including any of the following: warfarin use with INR not normalized to ≤ 1.4; direct oral anticoagulant taken < 24 hours before (< 48-72 hours in renal impairment); therapeutic-dose unfractionated heparin with aPTT not normalized or < 4-6 hours since the last dose; therapeutic-dose low-molecular-weight heparin < 24 hours since the last dose; clopidogrel or ticagrelor discontinued < 5 days before; thrombocytopenia (< 100,000/μL) or other clinically significant coagulopathy; local infection at the injection site
• Refusal to participate
• Chronic opioid use or opioid dependence
• Body mass index ≥ 35 kg/m²
• Pregnancy or breastfeeding
• Preoperative mechanical circulatory support (e.g., ECMO)