Cardiac Surgery
Conditions
Brief summary
Chronic pain is a common complication after cardiothoracic surgery. The prevalence of post-sternoyomy pain syndrome (PSPS) ranges from 33% to 91%. Exact pathogenetic mechanisms for developing chronic pain after sternotomy are unknown. Apart from intraoperative nerve damage and subsequent postoperative neuropathic pain, operation techniques, age, sex, pre-existing pain, genetic and psychosocial factors, severe postoperative pain, and analgesic management are suspected to have an impact on the development of PSPS .
Detailed description
Ultrasound-guided Pecto-intercostal Fascial Block (PIFB) has been advocated by some researchers for cardiac surgery. Pecto-intercostal fascial plane block (PIFB) is a novel, minimally invasive, regional fascial plane block technique. PIFB was first described by de la Torre in patients undergoing breast surgery . PIFB targets the anterior intercostal nerves as they run in the fascial plane between the pectoral and the intercostal muscles and emerge on either side of the sternum. Also, lidocaine, a short-acting local anesthetic, has been proved to have analgesic and anti-inflammatory effects . The application of lidocaine by continuous infusion in the intraoperative period and immediately after the surgery appears to reduce the immediate postoperative pain, and may prevent the PSPS
Interventions
PROCEDUREpecto intercostal fascial block using bupivacaine 0.25%
patients will receive bilateral ultrasound-guided pecto-intercostal fascial block using 20 ml of bupivacaine 0.25% for each side.
DRUGlidocaine infusion
1.5 mg/kg lidocaine will be administered after induction of anesthesia, then 2mg/kg/h lidocaine will be administered with continuous intravenous infusion until the end of the surgery.
Sponsors
Beni-Suef University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
1. age between 18 and 75 years. 2. patient scheduled to undergo elective on-pump cardiac surgery with sternotomy. 3. American Society of Anesthesiologists classification of physical status \< IV.
Exclusion criteria
1. emergency surgery. 2. off-pump surgery. 3. redo surgery. 4. ejection fraction less than 35%. 5. refusal of the patient. 6. known hypersensitivity to LA. 7. chronic opioid use or chronic pain patient. 8. psychiatric problems or communication difficulties. 9. liver insufficiency (defined as a serum bilirubin ≥ 34 μmol/l, albumin ≤ 35 g/dl, INR ≥ 1.7). 10. renal insufficiency (defined as a glomerular filtration rate \< 44 ml/min). 11. obstructive sleep apnea syndrom. 12. coexisting hematologic disorders. 13. pregnancy or breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total dose of morphine in the first 24 h postoperatively. | 24 hours postoperative | total morphine consumed in the first 24 hour |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NRS numerical rating scale. | 24 hours post operative | NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief |
| chronic postoperative pain in 3 months after operation according to numerical rating scale | within 3 months postoperative | NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief |
| Time to rescue analgesic | within 24 hour postoperative | time from extubation to the time the patiants given analgesia |
| time to extubation | within 24 hour post operative | from end of surgery to the time of extubation |
| length of intensive care stay | within one week | from end of surgery to the time of discharging to the surgical word |
Countries
Egypt
Contacts
CONTACTMariana A soliman, lecturer
PRINCIPAL_INVESTIGATORMariana A mansour, Lecturer
benisuef university hospital,Egypt
Outcome results
None listed