Transversus Thoracic Muscle Plane Block, Pecto-intercostal Fascial Block, Enhanced Recovery, Cardiac Surgery
Conditions
Brief summary
This work aims to assess the analgesic efficacies of transversus thoracic muscle plane block (TTPB) and transversus thoracic muscle plane block (TTPB) for open cardiac surgeries
Detailed description
In patients undergoing open cardiac operation, pain management is crucial to the improved recovery. Postcardiac surgery pain is significant due to the sternotomy. The sternotomy is commonly cited as the most painful location following cardiac surgery, and postoperative pain is at its worst within the first 24 hours. The transversus thoracic muscle plane block (TTPB) and the pectointercostal fascial block (PIFB) are new ultrasound (US)-guided regional anesthesia techniques planned to provide analgesia to the anterior thoracic wall. Both blocks primarily target the anterior cutaneous branches of the intercostal nerves (T2-T6), which are responsible for innervating the parasternal and medial anterior chest wall regions.
Interventions
Patients will receive pecto-intercostal fascial block intraoperatively (20 ml of bupivacaine 0.25% + 1 ml dexamethasone 8 mg).
Patients will receive transversus thoracic muscle plane block was performed intraoperatively (20 ml of bupivacaine 0.25% + 1 ml dexamethasone 8 mg).
OTHERSham (No Treatment)
Patients will receive bilateral superficial needle puncture at a location like transversus thoracic muscle plane block without any solution injected. Only 25 saline will be injected superficially.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age from 40 to 60 years. * Both sexes. * American Society of Anesthesiology (ASA) physical status II-III. * Body mass index (BMI) \< 35 kg/m2. * Underwent cardiac surgery (coronary artery bypass graft surgery with median sternotomy).
Exclusion criteria
* Valve replacement procedures. * Emergency operations. * Redo surgeries. * Minimally invasive approaches. * The presence of psychiatric disorders. * Cognitive impairment preventing accurate assessment using the verbal numerical rating scale (NRS). * Known hypersensitivity or a history of allergy to local anesthetics. * Had severe major organ dysfunction. * Left ventricular ejection fraction below 30%. * Pregnancy or breastfeeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total amount analgesic requirement | 24 hours postoperatively | In cases where rescue analgesia is required \[numerical rating scale (NRS) ≥4\], intravenous Nalbuphine 0.1 mg/kg will be given. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of pain | 24 hours postoperatively | Degree of pain will be assessed using Numerical rating scale (NRS) from 0 (no pain) to 10 (worst severe pain). NRS will be measured at 2h, 4h, 8h, 16h and 24h after surgery. |
| The number of patients required rescue analgesia | 24 hours postoperatively | The number of patients requires rescue analgesic will be recorded at 0, 3, 6, 12, 18, and 24 hours after extubation. |
| Postoperative nausea and vomiting (PONV) | 24 hours postoperatively | The patients will be verbally evaluated according to a descriptive five-point postoperative nausea and vomiting (PONV) scale at 0, 3, 6, 12, 18, and 24 hours after the extubation. If a score of 3 or more is registered, ondansetron 4 mg IV will be administered and repeated after 8 hours if required. The PONV scale is 0 = no nausea; 1 = slight nausea; 2 = moderate nausea; 3 = vomiting once; and 4 = vomiting more than once. |
| Time to extubation | 24 hours postoperatively | After the operation, the time until the patient is extubated will be recorded. |
| Length of stay in the intensive care unit. | Average 7 days postoperatively | The time from admission to the intensive care unit (ICU) to the time of discharge to the hospital ward; during the hospital stay, an average of 7 days. Total duration of stay in ICU will be recorded. |
| Assessment of Delirium | 24 hours postoperatively | Delirium will be assessed using the 3-minute diagnostic Confusion Assessment Method (CAM) (acute, inattention, disorganized thinking , altered of consciousness). The diagnosis of delirium by CAM requires presence of feature 1 \& 2 \& either 3 or 4. Delirium using the 3-minute diagnostic Confusion Assessment Method ( acute , inattention, disorganized thinking , altered of consciousness). The diagnosis of delirium by CAM requires presence of feature 1 \& 2 \& either 3 or 4. It will be evaluated 24 hrs after extubation. |
| Level of patient satisfaction | 24 hours postoperatively | Level of patient satisfaction estimated by a 5-point Likert scale (1:extremely dissatisfied; 2: unsatisfied; 3: neutral; 4: satisfied; 5: extremely satisfied). |
| Incidence of complications. | 7 days postoperatively | Any complications-directly related to the block or the drug used in the block- will be recorded. Complications can include local anesthetic toxicity, vascular injury, pneumothorax, failed block, and anaphylactic shock. |
Countries
Egypt
Contacts
CONTACTNoha H Abdelghany, MD
Outcome results
None listed