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Chronic Postoperative PainTEA-ESPB-IVNCT07257744

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

An observational study of Chronic Postoperative Pain and Open Heart Surgery, run by Karadeniz Technical University at 1 site in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial 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). Read more about this study

Who is it for?
Ages 18 to 85 years
What is being tested?
Intravenous Analgesia, Thoracic Epidural Analgesia (TEA) and Erector Spinae Plane Block (ESPB)
Type of treatment
Injection or infusion
How many people
90 participants
Where
1 siteTurkey (Türkiye)
Study dates
15 Feb 2025to 20 Apr 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adult patients aged 18 to 85 years who are scheduled to undergo open heart surgery with median sternotomy at Karadeniz Technical University Farabi Hospital. All participants will receive one of the routinely used postoperative analgesia methods (intravenous analgesia, thoracic epidural analgesia, or erector spinae plane block) as determined by the clinical anesthesia team. Only patients classified as ASA physical status I-III and able to provide informed consent are included. Individuals with major comorbidities that interfere with participation, prior cardiac surgery, chronic pain treatment, or contraindications to routine analgesia methods are excluded.

Who may be able to join

  • 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)

Who cannot join

  • 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
Show all 10Show fewer
  • 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

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Turkey (Türkiye)1 site, 1 recruiting
  • Karadeniz Technical University Farabi Hospital

    Trabzon, Trabzon

    Ali Akdoğan, 05322605414, draliakdogan@yahoo.com

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: A Comparative Evaluation of Intravenous Analgesia, Thoracic Epidural Analgesia, and Erector Spinae Plane Block on Chronic Postoperative Pain Following Open Heart Surgery

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.

Read the detailed description

This prospective observational study is designed to evaluate and compare three commonly used postoperative analgesia modalities in adult patients undergoing open heart surgery through median sternotomy: intravenous analgesia, thoracic epidural analgesia (TEA), and bilateral erector spinae plane block (ESPB). All analgesia techniques included in this study represent routine clinical practices performed by the anesthesia team, and no intervention is assigned according to a research protocol. Patients receive whichever analgesia method is chosen by the clinical anesthesia team based on individual clinical conditions. Thus, the study reflects real-world practice in a single tertiary cardiac surgery center.

The primary objective is to determine the effect of these analgesia methods on the development of chronic postoperative pain at 3 months following surgery. Chronic pain will be assessed using the Numeric Rating Scale (NRS) and the S-LANSS questionnaire, administered either via telephone or in-person follow-up. Secondary objectives include the evaluation of postoperative acute pain scores, additional analgesic consumption, extubation time, mobilization time, intensive care unit (ICU) length of stay, hospital length of stay, respiratory parameters, complications such as reintubation or need for non-invasive mechanical ventilation, bronchodilator use, sedation requirements, urine output, and perioperative hemodynamic stability. The study also aims to analyze the correlation between acute postoperative pain and subsequent chronic pain development.

Eligible patients are those aged 18-85 years, classified as ASA I-III, with a body mass index (BMI) below 35 kg/m², and scheduled for open heart surgery at Karadeniz Technical University Farabi Hospital. Exclusion criteria include coagulation disorders, infection at the intervention site, psychiatric disorders, chronic pain treatment, allergy to anesthetic agents, inability to cooperate or communicate, prior open heart surgery, chronic analgesic or antidepressant use, and significant comorbid conditions affecting participation.

Patients included in the study will have their perioperative data extracted from anesthesia records, ICU follow-up forms, and hospital medical charts. Routine postoperative pain measurements will be performed using the NRS. No additional procedures, medications, or interventions beyond routine care will be conducted.

The study aims to enroll 90 patients (30 per group). Data will be analyzed using Statistical Package for the Social Sciences (SPSS). Normality will be assessed using the Kolmogorov-Smirnov test. Parametric and nonparametric tests, including Student's t-test, Mann-Whitney U, chi-square test, repeated-measures ANOVA, and Friedman test, will be used as appropriate. A significance level of p < 0.05 will be accepted.

This study is expected to contribute to the understanding of analgesic strategies in cardiac surgery and their role in preventing chronic postoperative pain, improving recovery, and reducing complications.

Being tested
Intravenous Analgesia, Thoracic Epidural Analgesia (TEA), Erector Spinae Plane Block (ESPB)
Keywords
Open Heart Surgery, Chronic Postoperative Pain, Post-Sternotomy Pain, Thoracic Epidural Analgesia (TEA), Erector Spinae Plane Block (ESPB), Pain Management, Cardiac Anesthesia
Medical subject headings
Pain, Postoperative, Agnosia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intravenous AnalgesiaOther

    Also called IV Analgesia, Intravenous Pain Management

    Routine postoperative intravenous analgesia (opioid and/or non-opioid medications) administered according to standard clinical care. This is not assigned by protocol and represents usual practice.

  • Thoracic Epidural Analgesia (TEA)Other

    Thoracic epidural catheterization performed as part of routine postoperative analgesia management. This practice is determined by the clinical anesthesia team and not assigned by the study protocol.

  • Erector Spinae Plane Block (ESPB)Other

    Bilateral erector spinae plane block performed preoperatively as part of routine perioperative analgesia. The technique is applied at the discretion of the clinical anesthesia team and is not protocol-assigned.

Study groups in NCT07257744
Study groupRoleWhat they receive
Intravenous Analgesia Group (IV)Participants who receive routine postoperative intravenous analgesia (opioid and/or non-opioid medications) as determined by the clinical anesthesia team. No protocol-assigned intervention is applied; analgesia is selected based on routine clinical practice.
Receives: Other: Intravenous Analgesia; Other: Thoracic Epidural Analgesia (TEA); Other: Erector Spinae Plane Block (ESPB)
Thoracic Epidural Analgesia Group (TEA)Participants who receive thoracic epidural analgesia via an epidural catheter placed preoperatively for postoperative pain control. TEA is administered according to institutional routine practice and is not assigned by the study protocol
Receives: Other: Intravenous Analgesia; Other: Thoracic Epidural Analgesia (TEA); Other: Erector Spinae Plane Block (ESPB)
Erector Spinae Plane Block Group (ESPB)Participants who receive bilateral erector spinae plane block (ESPB) performed preoperatively for postoperative analgesia. This block is a routine clinical procedure and is not assigned or modified by the study protocol.
Receives: Other: Intravenous Analgesia; Other: Thoracic Epidural Analgesia (TEA); Other: Erector Spinae Plane Block (ESPB)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Chronic Postoperative Pain at 3 Months

    Chronic postoperative pain will be assessed 3 months after surgery using the Numeric Rating Scale (NRS, 0-10) and the S-LANSS questionnaire. Participants will be contacted via telephone or in-person follow-up. Chronic pain is defined as pain persisting beyond the expected healing period and lasting at least 3 months.

    Measured: 3 Months Postoperative

Secondary outcomes (8)
  1. Acute Postoperative Pain Scores

    Pain intensity will be measured using the Numeric Rating Scale (NRS, 0-10) at routine postoperative intervals in the ICU and ward.

    Measured: 0-72 hours postoperative

  2. Additional Analgesic Consumption

    Total amount and frequency of rescue analgesic medications administered during the postoperative hospital period.

    Measured: 0-72 hours postoperative

  3. Extubation Time

    Time from ICU admission after surgery to successful extubation, recorded from anesthesia and ICU charts.

    Measured: Up to 72 hours postoperative

  4. Mobilization Time

    Time to first mobilization (sitting, standing, or ambulation) recorded by ICU or ward nursing staff.

    Measured: Postoperative day 0-2

  5. ICU Length of Stay

    Duration of ICU stay in hours, extracted from patient records.

    Measured: Up to 7 days

  6. Hospital Length of Stay

    Total hospitalization duration from surgery to discharge.

    Measured: Up to 14 days

  7. Postoperative Respiratory Events

    Incidence of re-intubation, need for non-invasive mechanical ventilation (NIMV), bronchodilator therapy, or respiratory complications.

    Measured: Up to 14 days postoperative

  8. Correlation Between Acute and Chronic Pain

    Correlation analysis between early postoperative pain scores (NRS) and chronic pain severity (NRS + S-LANSS) at 3 months.

    Measured: From immediate postoperative period to 3-month follow-up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Dec 2025
  2. Study start15 Feb 2025
  3. Primary completion20 Dec 2025 (estimated)
  4. Study completion20 Apr 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
90 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07257744
Sponsor's protocol ID
KTU-ANES-CHRONICPAIN-2024-01
Acronym
TEA-ESPB-IV
Status last verified
Nov 2025
First submitted
19 Nov 2025
Last updated
2 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data (IPD) will not be shared. The study is based on clinical follow-up data collected for a single-center observational thesis project, and no data sharing plan has been established.

Publications

  • Yu H, Zheng JQ, Hua YS, Ren SF, Yu H. Influence of volatile anesthesia versus total intravenous anesthesia on chronic postsurgical pain after cardiac surgery using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials criteria: study protocol for a prospective randomized controlled trial. Trials. 2019 Nov 27;20(1):645. doi: 10.1186/s13063-019-3742-4.

    PubMed 31775854
  • Martorella G, McDougall GJ Jr. Barriers and Facilitators to the Prevention of Chronic Pain in the Subacute Phase After Cardiac Surgery. Pain Manag Nurs. 2021 Feb;22(1):28-35. doi: 10.1016/j.pmn.2020.09.004. Epub 2020 Nov 11.

    PubMed 33189543
  • Yan H, Chen W, Chen Y, Gao H, Fan Y, Feng M, Wang X, Tang H, Yin J, Qian Y, Ding M, Cang J, Miao C, Wang H. Opioid-Free Versus Opioid-Based Anesthesia on Postoperative Pain After Thoracoscopic Surgery: The Use of Intravenous and Epidural Esketamine. Anesth Analg. 2023 Aug 1;137(2):399-408. doi: 10.1213/ANE.0000000000006547. Epub 2023 Jul 14.

    PubMed 37267129
  • Elsharkawy H, Clark JD, El-Boghdadly K. Evidence for regional anesthesia in preventing chronic postsurgical pain. Reg Anesth Pain Med. 2025 Feb 5;50(2):153-159. doi: 10.1136/rapm-2024-105611.

    PubMed 39909548

Questions about this trial

What is this clinical trial studying?

An observational study of Chronic Postoperative Pain and Open Heart Surgery, run by Karadeniz Technical University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 2 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Ali AKDOGAN, MD (+905322605414, draliakdogan@yahoo.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Chronic Postoperative Pain at 3 Months (time frame: 3 Months Postoperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07257744, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Dec 2025.

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