Regional Blocks for CABG Artery Bypass Graft Surgery

Phase 3

Not yet recruiting

• Conditions: Analgesia After Coronary Artery Bypass Graft Surgery
• Interventions: Procedure: Fentanyl infusion; Procedure: Pectointercostal plane block and external oblique intercostal plane block

• Registration Number: NCT05691920
• Lead Sponsor: Alexandria University

Brief Summary

Pain control after CABG is an essential step to guard against postoperative complications such as lung atelectasis. This major step can be achieved by opioids or regional blocks.

Regional blocks allow better pain control and avoid side effects of opioid based pain control

Detailed Description

Ultrasound guided External oblique intercostal plane block and pectointercostal plane block for perioperative analgesia in coronary artery bypass graft surgery: Prospective randomized controlled study

Introduction:

Pain control is a vital component to achieve enhanced recovery after cardiac surgery. Effective postoperative pain control will reduce the incidence of numerous postoperative complications, can facilitate early mobilization and may result in earlier recovery.

Pain control is historically achieved by the administration of opioids, which is associated with well-documented side effects, such as sedation, respiratory depression, pruritus, hallucinations and postoperative nausea and vomiting (PONV). Enhanced recovery following coronary artery bypass grafting (CABG) has gained attention even though there is limited evidence on the efficacy and effectiveness of existing analgesic techniques.

The external oblique intercostal plane and pectointercostal plane blocks are a new modality that will be used to improve pain-related outcomes after CABG surgery, and has not been extensively investigated. Therefore, we will test the hypothesis that external oblique intercostal plane and pectointercostal plane blocks can reduce cumulative opioid consumption for the patients undergoing CABG surgery when added to conventional multi-model intravenous analgesic technique.

The aim of this prospective comparative investigation is to assess the impact of external oblique intercostal plane and pectointercostal plane blocks in a multimodal perioperative analgesic regimen and any related side effects in patients undergoing CABG surgery.

Patients and Methods:

A prospective study will be carried out in Alexandria Main University Hospital on 120 American society of anaesthesiologists (ASA) II, III physical status aged 40-60 years scheduled for major upper abdominal surgery, after approval of the Medical Ethics Committee and an informed written consent. Patients will be categorized into two equal groups, group I (60) will be subjected to bilateral external oblique intercostal plane and pectointercostal plane blocks and group II (60) will be subjected to fentanyl infusion at a rate of 1μg/kg/h. During the patient stay in the ICU, total analgesic requirements will be measured in both groups. Also, sedation level, duration of intubation and length of ICU stay will be assessed.

Study Timeline

• Status Verified: 2022-11
• Study First Submitted: 2023-01-11
• Study First Submitted QC: 2023-01-11
• Study First Posted: 2023-01-20
• Last Update Submitted: 2023-01-21
• Last Update Posted: 2023-01-25
• Study Start: 2023-02-01
• Primary Completion: 2023-07-01
• Study Completion: 2023-07-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

• patients undergoing CABG surgery

Exclusion Criteria

• BMI above 40
• allergy for drugs used
• complicated cases
• patient refusal
• chronic opioid use
• cognitive dysfunction
• chronic kidney disease

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Opioid group	Fentanyl infusion	Patients will be subjected to fentanyl infusion at a rate of 1μg/kg/h
Block group	Pectointercostal plane block and external oblique intercostal plane block	Patients will be subjected to bilateral external oblique intercostal plane and pectointercostal plane blocks

Primary Outcome Measures

Name	Time	Method
Postoperative fentanyl requirements for 24 hours	24 hours postoperatively	Visual analogue score will be measured every 2 hours

Secondary Outcome Measures

Name	Time	Method
Visual analogue score	24 hours postoperatively	Visual analogue score will be measured every 2 hours
Side effects	24 hours postoperatively	Any side effect related to fentanyl or block technique will be detected and treated properly
Rescue analgesia	24 hours postoperatively	0.5 microgram/kg fentanyl will be given if visual analogue score more than 4