Median Sternotomy, Pain Management
Conditions
Keywords
Median Sternotomy, Parasternal Plane Block
Brief summary
Effective pain control during pediatric cardiac surgery remains a major clinical challenge, particularly in procedures involving median sternotomy, which is associated with intense nociceptive stimulation. Inadequate intraoperative analgesia may lead to increased opioid requirements, hemodynamic instability, delayed extubation, and prolonged intensive care unit stay. Objective monitoring of nociception may provide valuable information beyond conventional hemodynamic parameters in this vulnerable population. This prospective randomized controlled study aims to evaluate the effect of ultrasound-guided parasternal plane block on intraoperative nociception in pediatric patients undergoing cardiac surgery with median sternotomy. Intraoperative nociception will be objectively assessed using the Pain Index Monitor (PAM), based on skin conductance measurements. The results of this study are expected to provide objective evidence regarding the efficacy of parasternal plane block in attenuating nociceptive responses during pediatric cardiac surgery and to support the integration of regional anesthesia techniques and objective nociception monitoring into perioperative pain management strategies for children.
Interventions
PROCEDUREParasternal Plane Block
Ultrasound-guided bilateral parasternal plane block will be performed after induction of general anesthesia. The block will be performed after induction of anesthesia using 0.25% bupivacaine, with a total dose of 1.5 mg/kg, administered in equal volumes to both sides. The procedure will be carried out by experienced anesthesiologists under sterile conditions.
PROCEDUREGroup without peripheral nerve block
Patients assigned to this group will undergo the surgical procedure under standard general anesthesia without the use of any peripheral nerve block techniques.
Sponsors
Diskapi Yildirim Beyazit Education and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
6 Months to 7 Years
Healthy volunteers
No
Inclusion criteria
* Age between 6 months and 7 years * Scheduled for elective congenital cardiac surgery * Planned median sternotomy * American Society of Anesthesiologists (ASA) physical status II-III * Hemodynamically stable preoperative condition * Written informed consent obtained from a parent or legal guardian
Exclusion criteria
* Emergency surgery or redo sternotomy * Age \<6 months or \>7 years * ASA physical status I or \>III * Severe neurological disorders preventing reliable application of behavioral pain scales * Failure to obtain written informed consent from a parent or legal guardian
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative PAM Pain Index | While administering anesthesia during the procedure/surgery | Comparison of intraoperative Pain Index Monitor (PAM) values between groups in pediatric patients undergoing cardiac surgery via median sternotomy. PAM Pain Index values will be recorded at predefined time points, including after induction of anesthesia, after block performance, at skin incision, during sternotomy, and during sternum closure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative Remifentanil Consumption | While administering anesthesia during the procedure/surgery | Comparison of total intraoperative remifentanil consumption between groups |
| Extubation Time | On the operation day | Comparison of the time from the end of surgery to tracheal extubation between groups. |
Countries
Turkey (Türkiye)
Contacts
CONTACTElif Şule Özdemir Sezgi
CONTACTAslı Dönmez
Outcome results
None listed