Efficacy of Serratus Posterior Superior Intercostal Plane Block (SPSIPB) in Cardiac Implantable Electronic Device Implantation (CIED): A Prospective, Double-Blind, Randomized Controlled Trial

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• Picked for Anesthesiology and Pain Medicine (top studies of the week, 2 August 2026).

Abstract

Background: This study evaluated the analgesic efficacy of the serratus posterior superior intercostal plane block (SPSIPB) in patients undergoing CIED implantation. Methods: In this study, 60 patients undergoing primary CIED implantation were randomized to receive either ultrasound-guided SPSIPB (n = 30) or a sham-control group procedure (n = 30). The primary outcome was perioperative pain intensity, assessed using the Visual Analog Scale (VAS) intraoperatively and at 3, 6, 12, and 24 h postoperatively. Secondary outcomes included postoperative sleep quality measured by the Sleep Quality Numeric Rating Scale (SQ-NRS), patient and physician satisfaction scores. Results: SPSIPB significantly reduced pain scores at all time points compared with the control group (all p < 0.001). Clinically significant intraoperative pain (VAS ≥ 4) occurred in 83.3% of controls but in none of the SPSIPB patients (p < 0.001). Postoperatively, clinically significant pain dropped from 93.3% in controls to just 3.3% with SPSIPB (p < 0.001), with the block group maintaining significantly lower pain scores at 3, 6, 12, and 24 h (mean reductions vs. control of 4.70, 4.13, 3.97, and 1.90 points, respectively; p < 0.001). SQ-NRS scores were lower in the SPSIPB group than in the control group (median 2 vs. 7, p < 0.001). Poor sleep quality (SQ-NRS ≥ 6) was observed in 80.0% of controls and in none of the SPSIPB patients. Patient and physician satisfaction were significantly higher in the SPSIPB group (median Likert score: 5 vs. 3, p < 0.001). Conclusions: Preoperative SPSIPB was associated with substantially lower perioperative pain scores and reduced rescue analgesic requirements during the first 24 h after CIED implantation. Improvements in postoperative sleep quality and patient-physician satisfaction were also observed; however, these secondary outcomes should be interpreted as exploratory. Larger multicenter trials are warranted to confirm the magnitude and generalizability of these findings.

Abstract as published, via PubMed.