• Jonathan G Bailey, Ayman Hendy, Victor Neira, Edgar Chedrawy, and Vishal Uppal.
• Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. Electronic address: jon.bailey@dal.ca.
• Br J Anaesth. 2025 Jan 24.

BackgroundModerate-to-severe pain is common after cardiac surgery, peaking during the first and second postoperative days. Several nerve blocks for sternotomy have been described; however, the optimal location for continuous catheters has not been established. This study assessed the feasibility of a larger trial evaluating the efficacy of serratus anterior plane (SAP) catheter analgesia for sternotomy pain.MethodsThis double-blinded trial included patients undergoing cardiac surgery via sternotomy. Bilateral SAP catheters were placed in all participants, and randomised to ropivacaine or placebo. We assessed feasibility based on predetermined endpoints: (1) average recruitment rate >4 per month; (2) protocol adherence rate >90%; (3) primary outcome measurement rate >90%; and (4) significant catheter-related adverse event rate ≤2%. The quality of recovery index (QoR-15) was compared using an independent t-test.ResultsOf 52 participants randomised, feasibility data were available for 50. A definitive study was deemed 'not feasible' in our standalone centre owing to a low recruitment rate (2.4 per month) and a high adverse event rate (pneumothorax rate 12%). There were no major protocol deviations but minor deviations in 12% of participants. Pain, opioid consumption, complications, and quality of recovery were not different between groups. Long-term pain at 3 months was low in both groups.ConclusionsA single-centre trial was deemed not feasible for our setting. With limited data, the quality of recovery was not different with ropivacaine dosing of bilateral SAP catheters for sternotomy pain.Clinical Trial RegistrationNCT04648774.Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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