Postoperative Pain and Enhanced Recovery After Cardiac Thoracotomy
Conditions
Interventions
Group S: General Anesthesia + Normal Saline + Postoperative Intravenous PCA Pump:Patients in this group received routine general anesthesia and routine postoperative intravenous analgesia. At the end
Group LP: General Anesthesia + Ropivacaine Transversus Thoracis Plane Block + Postoperative Intravenous PCA Pump:Patients in this group received ultrasound-guided parasternal intercostal plane block b
Group LB: General Anesthesia + Liposomal Bupivacaine Transversus Thoracis Plane Block + Postoperative Intravenous PCA Pump:Patients in this group received general anesthesia combined with liposomal bu
Sponsors
The First Hospital of Hebei Medical University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Patients scheduled for elective median sternotomy cardiac surgery; 2. No gender restriction; 3. Age > 18 years old; 4. American Society of Anesthesiologists (ASA) physical status classification ?-?, and New York Heart Association (NYHA) functional classification ?-?; 5. Signed informed consent form.
Exclusion criteria
Exclusion criteria: 1. Infection at the puncture site;? 2. Thoracic deformity;? 3. Abnormal coagulation function;? 4. Severely impaired left ventricular function before surgery with an ejection fraction < 30%; unstable hemodynamics before surgery requiring intra-aortic balloon pump support;? 5. Having a cardiac pacemaker implanted; emergency surgery or re-thoracotomy;? 6. Other cardiac surgeries requiring cardiopulmonary bypass during coronary artery bypass grafting, such as valve replacement or plasty, ventricular aneurysm resection, etc.; complicated with tumors, infectious diseases, or mental diseases;? 7. History of chronic pain;? 8. History of allergy to local anesthetics;? 9. Patients taking opioids or other addictive drugs for a long time;? 10. Inability to provide informed consent;? 11. Inability to complete the pain rating scale;? 12. Inability to understand or operate the patient-controlled analgesia (PCA) pump;? 13. Participated in another study to evaluate experimental drugs in the past 30 days.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Visual Analog Scale (VAS) scores were used to evaluate the pain of patients undergoing cardiac thoracotomy at rest and during activity within 48 hours after surgery. If the patients were in intubation or sedation status, the Revised Non-Verbal Pain Scale (NVPS-R) for adults was adopted for pain assessment.; | — |
Secondary
| Measure | Time frame |
|---|---|
| Hemodynamic Indicators:The changes of blood pressure and heart rate were monitored and recorded at the following time points: before and after skin incision, before and after sternotomy, and before and after sternal closure. These hemodynamic indicators were continuously tracked throughout the surgical process to evaluate the impact of anesthesia and block intervention on the patient's circulatory function.;Blood Gas and Metabolic Indicators: Arterial blood lactic acid and blood glucose levels were measured and recorded at the following time points: after induction of sedation on admission, during surgery, and at 6h, 12h, and 24h postoperatively. These indicators were used to evaluate the patient's metabolic status and stress response during the perioperative period, providing objective data support for the effectiveness of analgesic intervention.;Stress and inflammatory indicators: Concentrations of serum interleukin-1ß (IL-1ß), C-reactive protein (CRP), high-mobility group box 1 protein (HMGB-1) (inflammatory markers), cortisol, epinephrine, and norepinephrine (stress markers);Medication use indicators: Consumption of opioids and vasoactive drugs during surgery and within 48 hours postoperatively.;Postoperative recovery indicators: Time to tracheal extubation, duration of drainage tube indwelling, time to first flatus and defecation, time to ambulation, length of ICU stay, and total length of hospital stay.;Adverse reaction indicators: The incidence of perioperative adverse events, including postoperative delirium, nausea and vomiting, shivering, arrhythmia, respiratory depression, surgical site infection, pulmonary complications, etc.;Long-term recovery quality indicators: Quality of Recovery Score Q15 (QoR-15) at 3 months postoperatively.; | — |
Countries
China
Contacts
Public ContactLi Wang
The First Hospital of Hebei Medical University
Outcome results
None listed