Coronary Artery Disease, Pain Syndrome
Conditions
Keywords
Cardiac Surgery, Coronary Artery Bypass Graft Surgery, Regional Anesthesia, Transversus Thoracis Muscle Plane Block, Enhanced Recovery After Surgery, Pain, evaluated by visual analog scale score.
Brief summary
Coronary artery bypass graft surgery is the standard surgical treatment for coronary disease. However, there is no consensus on analgesic management in patients undergoing CABG. The aim of the study is to evualuate efficacy of bilateral transversus thoracis muscle plane (TTMP) block combined with systemic analgesia, compared to systemic analgesia only, in patients undergoing elective on-pump CABG surgery. Our main hypothesis is that a bilateral TTMP block performed after CABG surgery could reduce morphine consumption during the first 48 hours. The investigators conducted an age, gender and type of surgery-matched retrospective cohort study in the Montpellier University Hospital (France).
Interventions
PROCEDUREUltrasound guided Bilateral Transversus Thoracis Muscle Plane block
In the TTMP block group, an ultrasounded guided TTMP block was performed by an anesthesiologist, in ICU, before tracheal tube removal. Between the 4th et 5th rib, on each side, 40 ml of Ropivacaine 2 mg/ml, in association with Clonidine, was injected single-shot in the tranversus thoracis muscle plane. The targets of local anesthetic were the anterior branches of intercostal nerves from T2 to T6. Dexamethasone 8 mg was injected intravenously.
Sponsors
University Hospital, Montpellier
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* To be over 18 * To be scheduled for CABG surgery in the center of the study during the study period.
Exclusion criteria
* Chronic pain or opioid use before surgery * Recent thoracic regional analgesia (\< 1 month) * Preoperative dementia or other neurologic or psychiatric disease incompatible with VAS pain scoring. * Other technique of regional anesthesia (e.g. thoracic epidural) * Opposition to data collection Secondary exlusion criteria: * Postoperative prolonged sedation in ICU (\> 12 hours) * Postoperative surgical complication requiring surgical revision during the first two days. * Opposition to data collection expressed secondarily
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| cumulative morphine consumption | postoperative day 2 | cumulative morphine consumption during the first two days. cumulative morphine consumption on postoperative day 0, 1 and 2, including the morphine administered in intensive care unit, and on postoperative day 1 and 2. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative pain assessed | postoperative day 0, 1 and 2 | Postoperative pain assessed by visual analog scale (VAS) scoring |
| Postoperative nausea and vomiting | hospital day 7 | Postoperative nausea and vomiting |
| Occurrence of prurit | postoperative day 7 | Occurrence of prurit |
| rate of Delirium | postoperative day 7 | rate of Delirium |
| rate of Constipation | postoperative day 7 | rate of Constipation |
| rate of Urinary retention | until postoperative day 7 | rate of Urinary retention |
| rate of Hypotension | until postoperative day 7 | rate of Hypotension |
| Pleural drain duration | day 20 | Pleural drain duration |
| Urinary catheter duration | day 20 | Urinary catheter duration |
| Duration of hospitalization in ICU | day 20 | Duration of hospitalization in ICU |
| In-hospital length of stay | day 20 | In-hospital length of stay |
| Occurrence of atrial fibrillation | until postoperative day 7 | Occurrence of atrial fibrillation |
| rate of Pneumonia | until postoperative day 7 | rate of Pneumonia |
| acute kidney injury | until postoperative day 7 | acute kidney injury |
Countries
France
Outcome results
None listed