A Randomized Controlled Study for The Efficacy Of Parasternal Intercostal Block For Perioperative Analgesia In Cardiac Surgery at SMS Hospital, Jaipur

After obtaining approval from the institutional ethics committee and written informed consent patients scheduled for heart valve replacement surgery under general anaesthesia satisfying inclusion criteria will be enrolled in this study, NBM status, PAC consent will be checked in the operating room. Patient will be given T. Alprex 0.5mg   previous night.

Routine vital monitors will be attached for ECG, SpO2; EtCO2,entropy. Peripheral IV line, IJV central line ,arterial line for invasive BP monitoring secured and vitals (HR,SBP,DBP,CVP) will be noted before induction . After randomization, patients  (n=80) will be allocated into specific group as per study protocol by sealed  envelope method. Patient will be induced with Inj.Midazolam 0.05mg/kg and Inj.Fentanyl 4microgram/kg, Inj. Etomidate 0.3mg/kg, Inj. Rocuronium 0.9mg/kg to facilitate tracheal intubation. Patient will be mechanically ventilated by 100% O2 with tidal volume 6-8ml/kg.EtCo2 35-45mm Hg will be maintained by adjusting respiratory rate of 12-16 breathe per minute.

In Parasternal intercostal group, Group A, patients  will receive bilateral USG guided parasternal Intercostal block immediately after induction of general  anaesthesia  and intubation. The block will be excecuted with aseptic technique.The block will be given between the pectoral major and the intercostal muscles, proximal to the sternum from 2nd to 6th intercostal spaces..

with 40ml of 0.5% ropivacaine  plus 25 microgram fentanyl  (4ml in each space from 2nd to 6th intercostal space on each side) before incision and local infiltration of 10ml of 0.5%  ropivacaine  on  surgical drainage sites at the end of the surgery.

                                                                                                                                                  In Controlled group: Patients undergoing cardiac surgery under GA will receive only local infiltration of surgical drainage site at the end of the surgery. Hemodynamic parameters and fentanyl requirement will be assessed intraoperatively as per BIS.

In both the groups, patients will be shifted to ICU after surgery with ETT in situ.

In both the groups, IV fentanyl (25 µg/ml) at a basal infusion rate of 1ml/hour and a bolus of 1ml (fentanyl 25µg) given by the patient him/herself whenever needed with a lockout interval of 15 minutes for 48 hrs hours after extubation. If the patient will still experience pain ( VAS>= 4), then Inj tramadol 50mg will be given.

Hemodynamic parameters, fentanyl requirement , VAS score and pulmonary function( PEFR by wright’s peak flow meter) will be assessed immediately,2, 4, 6,12,18,24,30,36,42 and 48 hr post extubation. Side effects or complications if any will also be noted. End point of the study will be 48hrs after extubation.