Pain, Acute
Conditions
Brief summary
Patients experiencing pain after undergoing cardiac surgery may also experience prolonged immobilization, insufficient respiratory functions, and the inability to cough due to median sternotomy. Therefore, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and length of hospital stay of these patients will increase significantly. many facial plane blocks have been introduced as simple and safe intervention for thoracic wall anesthesia and analgesia. Parasternal intercostal nerve block (PSIB) is a superficial block which involves local anesthetic (LA) infiltration in the intercostal space around the sternum where the anterior branches of intercostal nerves exist. Intraoperative LA administration under direct vision of the surgeon ensures adequate delivery of drugs and minimizes bleeding complication or inadvertent administration in blood vessels. Meanwhile, Preoperative administration of LA guided by ultrasound imaging has been used in variable surgical settings with noticeable success because of preemptive inhibition of noxious stimuli.
Interventions
PROCEDUREpre-incisional parasternal intercostal block
LA will be administrated by the anesthesiologist under ultrasound guidance and before surgical incision On either side of thorax, 2 cm lateral to sternal edge from 2nd to 6th intercostal space, A volume of (4 mL) of 0.25% bupivacaine will be used
PROCEDUREpost-incisional parasternal intercostal block
LA will be administered by the cardiac surgeon before the sternal closure. injection will introduced 2 cm lateral to sternal edge from 2nd to 6th intercostal space and volume (4 mL) of 0.25% bupivacaine will be used.
Sponsors
Benha University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Age from 20-70 years, * Scheduled to undergo elective cardiac surgeries through median sternotomy involving cardiopulmonary bypass (CPB).
Exclusion criteria
* Patients requiring preoperative inotropes, mechanical ventilation or intra-aortic balloon pump, * patients who have previous cardiac surgery, * prolonged CPB time (CPB\>120 minutes), * Intubation time more than 12hrs or planned for overnight ventilation. * Allergy to any of used drugs, * opioids addiction, * Chronic liver disease, chronic renal disease, and cognitive impairment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Amount of rescue analgesia | 24 hours postoperative | Total amount of opioid administered as rescue analgesia postoperative. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| intraoperative mean arterial blood pressure (MAP) | during surgery (baseline, at skin incision, at sternotomy, at sternal retraction) | hemodynamic variability due to surgical stimulation |
| pain score (VAS) | at extubation, 12th, 16th, 20th, and 24th hour postoperative | VAS scores will be recorded by making a handwritten mark on a 10-cm line that represented a continuum between no pain and worst possible pain. |
| Intraoperative total fentanyl requirements | during surgery | the amount of consumed opioid during the procedure |
| patient satisfaction | 28 hours postoperative | 0 extremely unsatisfied to 10 extremely satisfied |
| Intensive Care Unit (ICU) Length of Stay | up to 6 months | — |
| adverse effects | 24 hours postoperative | nausea, vomiting, excessive sedation, respiratory depression |
Countries
Egypt
Outcome results
None listed