Pecto-Intercostal Fascial Block, Transversus Thoracis Muscle Plane Block, Cardiac Surgery, Postoperative Analgesia
Conditions
Brief summary
The aim of this study is to compare the effect of Ultrasound-Guided Pecto-Intercostal Fascial Block versus Transversus Thoracis Muscle Plane Block on Postoperative Pain Analgesia in Cardiac Surgery
Detailed description
Perioperative pain management is an essential component of the enhanced recovery pathway in patients undergoing cardiac surgery. The incidence of severe acute postoperative pain after median sternotomy is as high as 49%.
Interventions
PROCEDUREPecto-Intercostal Fascial Block
A high-frequency (7-12 Mhz) linear ultrasound transducer will be placed approximately 2 cm lateral to sternal edge in the 4th or 5th intercostal space. A 22-gauge, 50-mm needle will be inserted in-plane under ultrasound guidance. The needle will be advanced through the pectoralis major muscle, and the drug will be deposited in the pecto-intercostal fascial plane located between the pectoralis major muscle and the external intercostal muscles. The separation of the fascial plane and the spread of the drug could be observed on the ultrasound image .The procedure will be repeated on the other side of sternotomy to achieve bilateral blockade.
The ultrasound probe will be placed in the longitudinal plane 1 cm lateral to the sterna border. the T4-T5 intercostal space will be identified under US. A parasternal sagittal view of the internal intercostal muscle and the transverses thoracis muscle between the 4th and 5th rib will be visualized above the pleura. A 22-gauge, 50-mm needle will be inserted inplane until the tip of the needle is located in the transversus thoracis muscle plane between the internal intercostal and transversus thoracis muscles . After excluding intravascular and intrapleural placement, local anesthetic will be administered in 5mL aliquots with intermittent aspiration.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 90 adult patients of both sexes aged (21-60) scheduled for cardio-pulmonary bypass cardiac surgery (valve replacement) with midline sternotomy
Exclusion criteria
* Patients' refusal. * Cognitive impairment. * History of drug abuse& chronic analgesic use * History of allergy to local anesthetics. * Emergency surgery * Pre-existing major organ dysfunction including hepatic or renal failure, pulmonary insufficiency and left ventricular ejection fraction \< 30% * Known coagulopathy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative pain score | 24 hours postoperative | After extubation, patients will be evaluated for pain using numeric rating scale (NRS) score at 0,3,6,12,24 h for pain that ranged from (0 = no pain) to (10 = the worst imaginable pain). If score is ≥ 4, rescue analgesia will be given in the form of fentanyl in a dose of 0.5µg/kg by iv route. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total opioid consumption in first 24 hours after cardiac surgery | 24 hours Postoperative | If the pain score is ≥ 4, rescue analgesia will be given in the form of fentanyl in a dose of 0.5µg/kg by iv route. The time to the first request for analgesia and the total fentanyl dose will be documented. |
| duration of mechanical ventilation | 24 hours Postoperative | Duration of mechanical ventilation in intensive care unit. |
| Incidence of complications | 24 hours Postoperative | Incidence of complications within 24hrs will be recorded as hematoma, pneumothorax and toxicity from local anathesitic. |
Countries
Egypt
Contacts
Primary ContactAbdullah N. Eloraby, MD
Outcome results
None listed