CABG Graft Integrity, Pain Management, Parasternal Block
Conditions
Keywords
IMA, CABG, SPIPB
Brief summary
Influence of Superficial Parasternal Intercostal Plane Block (SPIPB) on Internal Thoracic Artery (ITA) Caliber and Surgical Harvesting Efficiency in Coronary Artery Bypass Grafting (CABG)
Detailed description
Parasternal intercostal blocks (PSB) represent a newer approach to post-sternotomy pain management. Studies suggest their effectiveness in providing postoperative analgesia , with a significant advantage being their suitability even during concurrent antiplatelet or anticoagulant therapy.In addition to its sympatholytic effects cause vasodilatation , a reduction in vascular resistance, and an increase in local blood flow . The effects are maintained up to the early postoperative period .
Interventions
DRUGBupivacaine
Superficial parasternal block will be given to assess diameter of IMA by using US to assess caliber and ease of harvesting.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Intervention model description
Receive parasternal block
Eligibility
Sex/Gender
ALL
Age
22 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* • Age group: Adult patients from age of 22 to 65 years. * Sex: Both sexes * Patients undergoing CABG with IMA harvesting
Exclusion criteria
* • Patients with pre-existing active bloodstream infection or systemic infection * Refuse consent * IMA graft not suitable * Morbidly obese (BMI \> 40 ) * Hemodynamic instability * Severe pulmonary disease * Previous thoracic surgeries (makes it difficult to harvest IMA) * Advanced malignancy or chronic disease with life expectancy less than six months * Emergency surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Internal Thoracic Artery (ITA) Diameter | Measured 15 minutes after the SPIPB injection by intraoperative ultrasound. | Change in the diameter of the Internal Thoracic Artery (ITA) measured in millimeters (mm) after SPIPB administration. |
| Change in Internal Thoracic Artery (ITA) Cross-Sectional Area | Measured 15 minutes after the SPIPB injection by Intraoperative ultrasound. | Change in the cross-sectional area of the Internal Thoracic Artery (ITA) measured in square millimeters (mm²) after SPIPB administration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time Required for ITA Harvesting | Measured during the surgical harvesting procedure. | Total time in minutes (min) required to harvest the Internal Thoracic Artery. |
| Technical Difficulty of ITA Harvesting | Assessed by the surgeon immediately after the harvesting procedure. | Assessed using a Technical Difficulty Scale. The scale ranges from 1 (Very Easy) to 5 (Very Difficult), where a higher score indicates a worse outcome (more difficult harvesting). |
| Postoperative Pain Score | Measured at 24 hours postoperatively. | Postoperative pain assessed using the Visual Analog Scale (VAS) for pain. The scale ranges from 0 mm (No Pain) to 100 mm (Worst Possible Pain), where a higher score indicates a worse outcome. |
| Postoperative Opioid Consumption | Measured over the first 24 hours postoperatively. | Total postoperative opioid consumption, measured in Morphine Milligram Equivalents (MME). |
| Intraoperative Hemodynamic Stability | Measured during the intraoperative period. | Incidence of significant hemodynamic instability (e.g., episodes of hypotension or hypertension requiring intervention). |
Countries
Egypt
Contacts
CONTACTSarah hamdy Elghareeb, MD
PRINCIPAL_INVESTIGATORSarah H Elghareeb, MD
Ain Shams
Outcome results
None listed