Bilateral Ultrasound Guided Pectoralis Nerve Block Induces Hemodynamic Stability With Reducing Systemic Stress Response for Off-pump Coronary Artery Bypass Graft
Condition: Analgesic Effects; Systemic Stress Response; Hemodynamic Stability
Study type: Interventional
Phase: Early Phase 1

Summary: 
      Opioids used in attenuation of the neuroendocrine stress response in patients undergoing
      off-pump coronary artery bypass graft (OPCAB) it produces predictable satisfactory analgesia
      and sedation but with side effects such as respiratory depression, drowsiness, and myocardial
      depression. Regional techniques may be encouraged to be anti-stress procedures and produce
      risk-free postoperative (OPCAB) period. Pectoralis nerve block (pecs block) appears to
      possess a great deal of promise for patients undergoing (OPCAB) because of low complication
      rates as it is less invasive regional analgesic technique when compared to paravertebral,
      thoracic epidural analgesia and parenteral analgesia.
    

Detailed description: 
      Aims: Ultrasound Guided Bilateral Pecs block would provide attenuation of the neuroendocrine
      stress response with hemodynamic profile stability, decreased analgesic consumption and
      improves patient postoperative outcomes after(OPCAB).

      Materials and Methods: A prospective, single-blind, controlled study enrolled forty patients
      between the age groups of 25 and 65 years undergoing (OPCAB) through midline sternotomy under
      general anesthesia and randomly allocated into two groups with 20 in each group. Group 1
      patients did not receive Pecs block (control group), patients were anesthetized to keep the
      heart rate and blood pressure within 25% of the baseline values. Whereas Group 2 patients
      received bilateral Pecs block preoperatively. Patients were extubated once they fulfilled
      extubation criteria. Heart rate, mean arterial blood pressure, Plasma levels of
      adrenocorticotropic hormone(ACTH) and cortisol, sufentanil consumption were determined at the
      following points: Basically (T0),immediately before the induction of anesthesia; (T1),
      immediately after tracheal intubation; (T2),immediately after sternotomy;( T3), 30 minutes
      after the start of surgery; and (T4), at the end of surgery. Ventilator duration, duration of
      ICU stay hospital stay were recorded postoperatively.
    

Intervention name(s): Bilateral Ultrasound Guided Pectoralis Nerve Block.
Intervention type(s): Drug
Intervention description(s): Using a 20-gauge 5 cm needle. Injection bupivacaine 0.25% used as a local anesthetic. The block was performed in a supine position with the arm slightly abducted. The ultrasound probe was placed at the midclavicular level infero-laterally to locate the axillary artery and vein and then moved laterally toward the axilla until pectoralis major, pectoralis minor, and serratus anterior muscles were identified at the level of the fourth rib. The needle was inserted in-plane with respect to the ultrasound probe. A volume of 20 ml of local anesthetic solution was deposited in the fascial plane between pectoralis minor and serratus anterior muscle, followed by withdrawal of the needle to the fascial plane between the pectoralis major and pectoralis minor muscle, where a volume of 10 ml was deposited. The block was performed similarly on the opposite side. Care was taken not to cross the toxic dose of bupivacaine (3 mg/kg).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Care Provider, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Pectoralis block; Opioids Consumption; off-pump