Anaesthesia
Conditions
Interventions
Transverse Thoracic Muscle Plane Block and Rectus Sheath Block
General anesthesia without nerve blocks
Sponsors
Faculty of Medicine Ain Shams University
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Patients with American Society of Anesthesiologists (ASA) score III – IV. 2. Patients from both sexes. 3. Patients aged = 18 years old. 4. Patients scheduled for certain cardiac surgery with median sternotomy including valve(s) replacement/repair, surgical repair for ascending aorta, closure of congenital Atrial Septal Defect (ASD), and coronary artery bypass grafting (CABG) surgery using a NON Internal Thoracic Arterial graft.
Exclusion criteria
Exclusion criteria: 1. Patients refusing to be involved in this study. 2. Patients with ASA score > IV. 3. Patients aged < 18 years. 4. Patients scheduled for an expected CABG surgery using the Internal Thoracic Artery. 5. Patients scheduled for pericardial effusion drainage, surgical debridement or re-wiring the sternal bone. 6. Patients scheduled for urgent cardiac surgery. 7. Patients with local infection at the site of needle puncture. 8. Patients with known hypersensitivity to local anesthetic (LA). 9. Patients with possible development of LA toxicity (i.e. decompensated hepatic patients). 10. Patients hardly to be candidates for Fast Tract Extubation in ICU such as: - Patients on high doses of inotropes and/or vasopressors. - Patients with high drain(s) in the first 6 hours post-operatively. - Patients who needed an intra-aortic balloon pump (IABP) post- CardioPulmonary Bypass (CPB). - Patients who needed a cardiac temporary pacing. - Patients with delayed recovery (= 6 hours post-operative) in the ICU due to hypotension, stroke, brain edema, hypothermia, acidosis... etc.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The initial consumption of opioids mainly Fentanyl with the skin incision and sternotomy incision | — |
Secondary
| Measure | Time frame |
|---|---|
| The total peri-operative consumption of opioids including intra-operative Fentanyl and Morphine, and post-operative Morphine increments in the post cardiac surgery care unit according to the pain score assessment ;Post-operative pain assessment using the Visual Analogue Scale (VAS). It consists of a 10 cm straight line with the endpoints defining extreme levels of ‘NO pain at all’ (0 cm) and ‘pain as bad as it could be’ (10 cm). A blind observer is asked to mark the pain level he is observing on the patient in the ICU on the line between these two endpoints. The distance between 0 and the mark then denotes the patient’s pain score.;Time needed to extubate the patient post-operatively in the post cardiac surgery care unit as an indicator of better lung mechanics due to decreased levels of pain | — |
Countries
Egypt
Contacts
Public ContactFady Nessim
Assistant Lecturer in Department of Anesthesia Faculty of Medicine Ain Shams University
Outcome results
None listed