Ultrasound-Guided Bilateral Pecto-intercostal Fascial Block Versus Intravenous Fentanyl for Postoperative Pain Management After Pediatric Cardiac Surgery A Prospective, Randomized, Controlled Study
Overview
- Phase
- Not Applicable
- Intervention
- Ultrasound-guided bilateral pecto-intercostal fascial block
- Conditions
- Pediatric Patients
- Sponsor
- Mansoura University
- Enrollment
- 80
- Locations
- 1
- Primary Endpoint
- Total dose of fentanyl requirements
- Last Updated
- 4 years ago
Overview
Brief Summary
Cardiac surgical patients often experience significant postoperative pain at the median sternotomy site.
In pediatric cardiac surgery, the recommended pre bypass dose of fentanyl to blunt the hemodynamic and metabolic stress response is 25-50 µg/kg Today lower doses are often used in order to achieve early extubation at such doses there is no guarantee that the stress response is completely abolished one way to overcome this problem is the use of the local anesthetic technique Regional anesthetic techniques reduce pain for up to 24 hours after cardiac surgery in children.
Pectointercostal fascial block was first described by de la Torre in patients undergoing breast surgery. This novel technique blocks the anterior cutaneous nerve which is a branch of the intercostal nerve that gives sensory supply to the skin.
Detailed Description
The aim of the current study is to detect the effectiveness of pecto-intercostal fascial block in relieving postoperative pain in noncyanotic pediatric patients undergoing elective cardiac surgery the primary goal of this randomized study is to compare the postoperative pain score in the first postoperative 24 hours and to detect total dose of fentanyl requirements. The secondary goals are intraoperative hemodynamic stress response to surgical stimuli, analgesic consumption in the studied groups, cross-clamping and bypass time, time to extubation, intensive care length of stay, and postoperative complications.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Elective repair of congenital simple left to right intracardiac shunt
- •Median sternotomy
Exclusion Criteria
- •Refusal of their guardians
- •Redo cardiac surgery
- •Previous back injury
- •Previous back surgery
- •Kyphoscoliosis
- •Local infection of the skin and subcutaneous tissue at the site of needle puncture
- •Hypersensitivity to local anesthetics
- •Coagulation disorders
- •Renal disease
- •Hepatic disease
Arms & Interventions
Ultrasound-guided bilateral pecto-intercostal fascial block
Patients will receive bilateral ultrasound-guided pecto-intercostal fascial block
Intervention: Ultrasound-guided bilateral pecto-intercostal fascial block
Intravenous fentanyl
Patients will receive only incremental doses of intravenous fentanyl
Intervention: Sevoflurane
Ultrasound-guided bilateral pecto-intercostal fascial block
Patients will receive bilateral ultrasound-guided pecto-intercostal fascial block
Intervention: Propofol
Ultrasound-guided bilateral pecto-intercostal fascial block
Patients will receive bilateral ultrasound-guided pecto-intercostal fascial block
Intervention: Sevoflurane
Ultrasound-guided bilateral pecto-intercostal fascial block
Patients will receive bilateral ultrasound-guided pecto-intercostal fascial block
Intervention: Atracurium
Ultrasound-guided bilateral pecto-intercostal fascial block
Patients will receive bilateral ultrasound-guided pecto-intercostal fascial block
Intervention: ultrasound
Intravenous fentanyl
Patients will receive only incremental doses of intravenous fentanyl
Intervention: Intravenous fentanyl
Intravenous fentanyl
Patients will receive only incremental doses of intravenous fentanyl
Intervention: Propofol
Intravenous fentanyl
Patients will receive only incremental doses of intravenous fentanyl
Intervention: Atracurium
Outcomes
Primary Outcomes
Total dose of fentanyl requirements
Time Frame: intraoperative and 24 hrs postoperatively
Total dose of fentanyl requirements
Postoperative pain assessment
Time Frame: Postoperative day 1
Postoperative pain will be assessed using the modified objective pain score (OPDS) in children.
Secondary Outcomes
- Serum cortisol levels(Basal and one-hour postoperatively)
- Heart rate [HR](before induction of anesthesia (basal value), after induction of anesthesia, after skin incision, after sternotomy, 15 min after CPB and after the closure of sternum)
- Invasive mean arterial blood pressure [MAP](before induction of anesthesia (basal value), after induction of anesthesia, after skin incision, after sternotomy, 15 min after CPB and after the closure of sternum)