Comparison of IV Analgesia, Thoracic Epidural Analgesia, and ESP Block for Chronic Pain After Open Heart Surgery

Summary

This prospective observational study aims to compare three routinely used postoperative analgesia techniques in patients undergoing open heart surgery: intravenous analgesia, thoracic epidural analgesia (TEA), and bilateral erector spinae plane block (ESPB). The primary objective is to evaluate the impact of these analgesia modalities on the development of chronic postoperative pain at 3 months. Secondary objectives include assessing postoperative acute pain scores, additional analgesic requirements, extubation time, mobilization time, intensive care unit stay, hospital stay, respiratory complications, and the relationship between acute and chronic pain. No intervention is assigned by protocol, and all analgesia methods are applied as part of routine clinical practice.

Eligibility

Inclusion Criteria:

* Adults aged 18 to 85 years
* Classified as ASA physical status I-III
* Scheduled to undergo open heart surgery with median sternotomy
* BMI \< 35 kg/m²
* Able to understand and provide written informed consent
* Eligible to receive any of the routine analgesia methods (intravenous analgesia, thoracic epidural analgesia, or erector spinae plane block)

Exclusion Criteria:

* Age \< 18 or \> 85 years
* BMI ≥ 35 kg/m²
* Coagulation disorders
* Infection at the intervention site
* Known allergy to local anesthetics or induction agents
* Psychiatric disorders limiting cooperation
* Use of chronic pain medications, antidepressants, corticosteroids, antiepileptics, or routine analgesics
* Inability to cooperate, communicate, or follow commands
* Physical or verbal performance impairment
* Previous open heart surgery

Conditions5

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