Pecto-Intercostal Fascial Block vs. Transversus Thoracic Muscle Plane Block in Cardiac Surgery
Condition: Pain, Postoperative; Coronary Artery Disease
MeSH terms: Coronary Artery Disease; Pain, Postoperative
Study type: Interventional

Summary: 
      In patients undergoing open cardiac surgery, pain control is an essential part of the
      enhanced recovery process. The current study aimed to evaluate the analgesic efficacies of
      ultrasound-guided pecto-intercostal fascial block and ultrasound-guided transversus thoracic
      muscle plane block for open cardiac surgeries. Analgesic efficacy will be assessed on the
      numeric rating scale (NRS) along with intraoperative and 24 h postoperative opioid
      consumption.
    

Detailed description: 
      It has been reported that the TTMP block and PIF block produce effective postoperative
      analgesia for open cardiac surgeries.

      The hypothesis of our study; PIF block reduces pain and analgesic consumption in the acute
      period (0-24 hours) similar to TTP block in patients undergoing elective cardiac surgery
      requiring median sternotomy.

      Patients will be divided into two groups:

      Group PIFB: A bilateral PIF block will be performed intraoperatively (20 ml, %0.25
      bupivacaine + 1:400.000 adrenaline). In addition, IV morphine patient-controlled analgesia
      (PCA) will be applied postoperatively for 24 hours.

      Group TTMPB: A bilateral TTMP block will be performed intraoperatively (20 ml, %0.25
      bupivacaine + 1:400.000 adrenaline). In addition, IV morphine-PCA will be applied
      postoperatively for 24 hours.
    

Intervention name(s): Single-injection, ultrasound-guided bilateral PIF block.; Single-injection, ultrasound-guided bilateral TTMP block.
Intervention type(s): Procedure; Procedure
Intervention description(s): PIF block bilaterally (20 ml, 0.25% bupivacaine + 1:400.000 adrenaline). In addition, LA infiltration (10 ml, 0.25% bupivacaine) will be performed by the surgeon around the chest tube in all patients.
Intraoperative analgesia: At the end of the surgery, all patients will be given 0.05 mg/kg morphine IV.
Postoperative analgesia: Paracetamol 1 gr IV (every 6 hours) and IV PCA of 0.5 mg/ml morphine (demand dose 20µg/kg; lock out interval 6-10 min.; the 4-hour limit will be 80% of the total calculated dose).
In cases where rescue analgesia is required (NRS score ≥4) tramadol 100 mg IV will be infused within 30 minutes (max. 300 mg / day).
For postoperative nausea and vomiting prophylaxis, patients will be routinely administered ondansetron 4 mg IV 20 minutes before extubation in the intensive care unit.; TTMP block bilaterally (20 ml, 0.25% bupivacaine + 1:400.000 adrenaline). In addition, LA infiltration (10 ml, 0.25% bupivacaine) will be performed by the surgeon around the chest tube in all patients.
Intraoperative analgesia: At the end of the surgery, all patients will be given 0.05 mg/kg morphine IV.
Postoperative analgesia: Paracetamol 1 gr IV (every 6 hours) and IV PCA of 0.5 mg/ml morphine (demand dose 20µg/kg; lock out interval 6-10 min.; the 4-hour limit will be 80% of the total calculated dose).
In cases where rescue analgesia is required (NRS score ≥4) tramadol 100 mg IV will be infused within 30 minutes (max. 300 mg / day).
For postoperative nausea and vomiting prophylaxis, patients will be routinely administered ondansetron 4 mg IV 20 minutes before extubation in the intensive care unit.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The patients will be randomly classified into two groups.
Masking: Double (Participant, Investigator)
Primary purpose: Supportive Care
Keywords: Pain, Postoperative; Surgery, Cardiac; Nerve, Block