Analgesia, Perioperative Analgesia, Regional Block Technique
Conditions
Keywords
Parasternal block; Rectus sheath block; ESPB; Analgesia
Brief summary
The researchers are working to improve recovery after heart surgery by reducing reliance on opioids. Newer regional anesthesia techniques can provide strong pain relief with fewer risks, but the choice of method depends on each patient's condition, medications, and surgical plan
Detailed description
Optimal anesthesia in cardiac surgery requires careful management to avoid sympathetic stimulation, with analgesia being central to patient safety and recovery. Traditionally, high-dose opioids were used, but this approach delays extubation, conflicting with fast-track protocols that emphasize early extubation. Consequently, opioid-free analgesia has gained importance, employing regional techniques such as neuraxial, paravertebral, and fascial plane blocks. Thoracic epidural analgesia (TEA) offers effective pain control and reduces perioperative cardiovascular and respiratory complications. However, its use in anticoagulated patients raises concern for epidural hematoma. Alternatives like paravertebral and fascial plane blocks provide comparable analgesia with lower risk. The erector spinae plane block (ESPB) reduces analgesic requirements, though deep blocks still pose bleeding risks. Superficial plane blocks are therefore clinically valuable. The parasternal intercostal block-targeting anterior cutaneous branches of intercostal nerves-has emerged as a safe option for patients undergoing median sternotomy while on anticoagulant or antiplatelet therapy. Additionally, bilateral rectus sheath block can reduce chest tube insertion pain after cardiac surgery.
Interventions
PROCEDUREParasternal/ Rectus sheath block
the parasternal block will be performed parasternally at the level of fifth rib to the plane between the pectoralis major and the internal intercostal muscle. The rectus sheath block will be performed through injection in the plane posterior to the rectus abdominis muscle and anterior to the posterior rectus sheath
PROCEDUREErector spinae plane block
injection above the transverse process
Sponsors
National Cancer Institute, Egypt
Saudi German Hospital - Madinah
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Intervention model description
2
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Both sexes, * ASA III-IV patients * body mass index between 20- 35 kg/m2 * adult patients above 18 years old will be included in the study
Exclusion criteria
* Patients with global hypokinesia * ejection fraction \< 40% * low platelet count * coagulation impairment * deformity in the vertebral column * severe renal and hepatic impairment * any known allergy to the drugs used
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric rating score | 24 hours | postoperative pain scores using Numerical Rating Scale (NRS) with 0 meaning no pain and 10 meaning the worst pain level |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| postoperative opioid consumption | 24 hours | opioid consumption in the first 24 hours postoperatively |
| extubation time | immediate postoperative | time to extubate |
| first time to request analgesia | 24 hours | first time to request opioid analgesia |
| peri-operative hemodynamics | intraoperative and 24 hours | incidence of hypotension, hypertension, tachycardia and bradycardia |
Contacts
CONTACTWalaa Y Elsabeeny, MD
CONTACTMostafa A Ibrahim, MD
PRINCIPAL_INVESTIGATORWalaa Y Elsabeeny, MD
A Professor of Anesthesia, Critical Care and Pain Management, National Cancer Institute, Cairo University
Outcome results
None listed