Ultrasound-guided Erector Spinae Plane Block in Combination with Superficial Parasternal Intercostal Plane Block Versus Paravertebral Block for Perioperative Pain after Median Sternotomy Surgeries

Background: Postoperative pain management improves cardiac surgery outcomes. Sternotomy is the primary source of pain, with nerve injury, pleural involvement, and chest drains contributing. Ultrasound-guided interfacial plane blocks, including the paravertebral block (PVB), erector spinae plane block (ESPB), and superficial parasternal intercostal block (S-PIP), reduce analgesic needs and opioid use.Objectives: This study compares the Perioperative analgesic effects of S-PIP + ESP versus PVB in elective median sternotomy.Patients and methods: A randomized clinical trial at Qena University Hospitals (March 2023–February 2025) included 57 patients (ASA II–III, 18–70 years). Group A (n=29) received ESP + S-PIP, while Group B (n=28) received PVB. Pain was assessed using the Numerical Rating Scale (NRS) with patient-controlled analgesia (PCA) and rescue tramadol. Opioid use and adverse events were monitored for 48 hours.Results: No significant differences were found in patient characteristics, operative data, extubation time, 48-hour morphine use, or overall outcomes (P>0.05). However, Group A had significantly lower NRS at 4 hours (2.55 ± 0.736 vs. 3.14 ± 0.756, P = 0.004) and during coughing at 0, 2, and 6 hours (P<0.001).Conclusion: S-PIP + ESP provides comparable analgesia to PVB in sternotomy patients, with similar morphine consumption, pain scores, and rescue analgesia needs. No significant differences were noted in ICU stay, extubation time, or hospital stay, supporting S-PIP + ESP as an effective alternative to PVB.