Ischemic Heart Disease (IHD), Off-pump Coronary Artery Bypass, Regional Block for Pain Control
Conditions
Brief summary
In cardiac surgery patients , effective pain control is crucial to support early extubation, mobilization, and cognitive recovery, yet systemic opioids carry substantial risks such as respiratory depression, delirium, and delayed rehabilitation. While regional fascial plane blocks offer a safer, opioid-sparing alternative, no single technique provides complete analgesia for the complex and multi-dermatomal pain generated by sternotomy, graft harvesting, chest wall retraction, and drain sites. Therefore, a multimodal approach combining blocks such as parasternal nerve block , rectus sheath nerve block and femoral nerve block , may cover most of areas expected to be sources of intraoperative and post-operative pain in cardiac surgery patients.
Interventions
PROCEDUREregional nerve block with local anesthesia
Patients will receive bilateral superficial parasternal nerve block using 20 mL of 0.25% bupivacaine per side, in combination with a rectus sheath block (RSB) using 10 mL of 0.25% bupivacaine per side. and femoral nerve block at the side of harvesting using 10 mL of 0.25% bupivacaine.
PROCEDUREPlacebo
Patients will receive placebo (saline) injections administered in the same anatomical planes.
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* o Scheduled for elective off-pump coronary artery bypass graft (OPCAB) surgery via median sternotomy * American Society of Anesthesiologists (ASA) physical status III - IV * Ability to provide informed consent
Exclusion criteria
* o Emergency or redo cardiac surgery * On-pump CABG or concomitant valve or aortic procedures * Known allergy to local anesthetics or study drugs * Coagulopathy or ongoing anticoagulant therapy contraindicating regional block * Preoperative chronic opioid use or opioid dependency * Neurologic or psychiatric conditions interfering with pain assessment * Infection at the block injection site * Severe hepatic or renal impairment * Body mass index (BMI) \> 40 kg/m² * Inability to understand or cooperate with pain scoring or postoperative care.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Extubation | from transferal to ICU until successful tracheal extubation assessed during post operative ICU stay up to 48 hours | Defined as the interval (in hours) from transferal to ICU to successful tracheal extubation |
Countries
Egypt
Contacts
CONTACTAbdelrahman H Ashour
STUDY_DIRECTORSherif S Sultan, MD
faculty of medicine Ain Shams university
Outcome results
None listed