Postoperative Pain Alleviation in Patients Undergoing Cardiac Surgery; Presternal Bupivacaine and Magnesium Infiltration Versus Conventional Intravenous Analgesia
Overview
- Phase
- Not Applicable
- Intervention
- bupivacain with magnesium sulphate
- Conditions
- Open Heart Surgery
- Sponsor
- Assiut University
- Enrollment
- 90
- Locations
- 1
- Primary Endpoint
- postoperative pain
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
Effective pain relief after cardiac surgery has assumed importance with the introduction of fast track discharge protocols that requires early weaning from mechanical ventilation. Inadequate pain control reduces the capacity to cough, mobility, increases the frequency of atelectasis, and prolongs recovery. Infiltration of local anesthetics near the surgical wound has shown to improve early postoperative pain in various surgical procedures.
Magnesium is the fourth most plentiful cation in our body. It has antinociceptive effects in animal and human models of pain.
Detailed Description
Effective pain relief after cardiac surgery has assumed importance with the introduction of fast track discharge protocols that requires early weaning from mechanical ventilation. Inadequate pain control reduces the capacity to cough, mobility, increases the frequency of atelectasis, and prolongs recovery. A major cause of pain after cardiac surgery is the median sternotomy particularly on the first two postoperative days. The most often used analgesics in these patients are parenteral opioids which can lead to undesirable side-effects as sedation, respiratory depression, nausea, and vomiting. Infiltration of local anesthetics near the surgical wound has shown to improve early postoperative pain in various surgical procedures. Magnesium is the fourth most plentiful cation in our body. It has antinociceptive effects in animal and human models of pain. It has been mentioned in a systematic review that it may be worthwhile to further study the role of supplemental magnesium in providing perioperative analgesia, because this is a relatively harmless molecule, is not expensive and also because the biological basis for its potential antinociceptive effect is promising. These effects are primarily based on physiological calcium antagonism, that is voltage-dependent regulation of calcium influx into the cell, and noncompetitive antagonism of N-methyl-D-aspartate (NMDA) receptors. there is a need to evaluate and compare local magnesium with bupivacaine , in comparison to bupivacain ,and other conventional intarvenous analgesics
Investigators
Emad Zarief , MD
lecturer of anesthesia and ICU
Assiut University
Eligibility Criteria
Inclusion Criteria
- •18-60 years old
- •American Society of Anesthesiologists physical status II and III
- •Patients scheduled for open heart valve replacement surgery with sternotomy
Exclusion Criteria
- •Emergency surgery
- •Clinically significant kidney or liver disease
- •Patients allergic to local anesthetic
- •Patients with prolonged CPB time (\>120 min)
- •Patients required intra-aortic balloon pump
Arms & Interventions
group A
( bupivacain 0.125% magnesium sulfate 5%) infusion in the presternum , for 48 hours
Intervention: bupivacain with magnesium sulphate
group B
bupivacaine 0.125% infusion in the presternum , for 48 hours
Intervention: Bupivacaine only
Group C
will be conventional , will receive postoperative fentanyl , paracetamol , and ketorolac.
Intervention: conventional
Outcomes
Primary Outcomes
postoperative pain
Time Frame: 48 hours postoperative
Vas Scale
Secondary Outcomes
- extubation time(48 hours)
- Fentanyl consumption(48 hours)