Cardiac Surgery, Median Sternotomy, Postoperative Pain
Conditions
Keywords
Parasternal Block, Wound Site Infiltration, Opiorphin, Median Sternotomy, Postoperative Analgesia
Brief summary
This study evaluated the effects of parasternal block and wound site infiltration on postoperative pain in patients undergoing median sternotomy. Patients were allocated to receive parasternal block, wound site infiltration, or standard systemic analgesia. Salivary opiorphin levels and postoperative pain scores were assessed to compare analgesic effectiveness between the groups.
Detailed description
This randomized prospective study included patients undergoing surgery through median sternotomy. The study compared three perioperative analgesic approaches: parasternal block, wound site infiltration, and standard systemic analgesia without local intervention at the surgical site. Salivary samples were collected before surgery, after sternotomy, and during the postoperative period to measure opiorphin levels. Postoperative pain was assessed using visual analogue scale scores, and additional analgesic requirement, opioid consumption, extubation time, intensive care unit stay, and adverse effects such as nausea and vomiting were recorded.
Interventions
PROCEDUREParasternal blocks
Ultrasound-guided parasternal block was performed with local anesthetic before surgical incision.
PROCEDUREWound Site Infiltration
Local anesthetic infiltration was performed at the surgical wound site before surgical incision.
Sponsors
Ataturk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Participants and postoperative outcome assessors were blinded to group assignment. In addition, laboratory personnel performing salivary opiorphin measurements were blinded to treatment allocation.
Intervention model description
Participants were assigned to one of three parallel groups: parasternal block, wound site infiltration, or standard systemic analgesia.
Eligibility
Sex/Gender
ALL
Age
30 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for surgery through median sternotomy * Patients who provided informed consent
Exclusion criteria
* Age under 30 years * Presence of ischemic, inflammatory, or systemic disease, except cardiovascular disease * Use of analgesic medication within the last 24 hours * Diagnosis of psychiatric disorder * Presence of any oral pathology, including active dental caries, aphthous lesions, or salivary gland inflammation * Prolonged intubation or inability to be separated from mechanical ventilation for more than 8 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Salivary Opiorphin Level | Baseline, 3 minutes after sternotomy, and postoperative 6 hours | Salivary opiorphin levels were measured using ELISA to evaluate the analgesic effect of the study interventions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity Assessed by the Visual Analogue Scale | At 1, 2, 4, 8, 12, and 24 hours after extubation | Postoperative pain intensity was assessed using the Visual Analogue Scale. The scale ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate worse postoperative pain. |
| Additional Analgesic Requirement | Within the first 24 hours after extubation | The need for rescue analgesia was recorded during the postoperative follow-up period. |
| Total Opioid Consumption | Within the first 24 postoperative hours | Total opioid consumption delivered by patient-controlled analgesia was recorded. |
| Extubation Time | Immediately after surgery until tracheal extubation, assessed up to 24 hours postoperatively | Time to extubation was defined as the duration from the end of surgery to tracheal extubation and was recorded in minutes. |
| Intensive Care Unit Length of Stay | From postoperative intensive care unit admission until intensive care unit discharge, assessed up to 7 days postoperatively | Intensive care unit length of stay was defined as the duration from admission to the intensive care unit after surgery until discharge from the intensive care unit and was recorded in hours. |
| Postoperative Nausea and Vomiting | Within the first 24 postoperative hours | Postoperative nausea and vomiting were recorded as adverse effects. |
Countries
Turkey (Türkiye)
Contacts
STUDY_DIRECTORMuhammed Enes Aydin, professor
Ataturk University Department of Anesthesiology and Reanimation
Outcome results
None listed