Pecto-intercostal Fascial Plane Block for Postoperative Analgesia and Recovery Profile After Off-Pump Coronary Artery Bypass Surgery
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

Summary: 
      Moderate to severe postoperative pain is usually encountered after cardiac surgery.Improper
      postoperative pain control could have multiple hemodynamic hazards in addition to prolonged
      postoperative ventilatory support and intensive care unit stay .The safety and efficacy of
      ultrasound guided chest wall plane blocks has been described for postoperative analgesia
      after cardiac surgeries.

      Study objective: to investigate the effect of adding of pecto-intercostal fascial plane block
      on the postoperative pain control, perioperative analgesic consumptions and the time for
      ventilation weaning and intensive care unit discharge in patients who will undergo off-pump
      Coronary artery bypass surgeries.

      Methods: This study patients will be randomly assigned to 2 Groups to receive preoperative
      ultrasound-guided pecto-intercostal fascial plane block with either 20 mL of 0.25%
      bupivacaine with adrenaline 1:400,000 or saline bilaterally.
    

Detailed description: 
      After preoperative patients' anesthesia assessment; the study patients (20 in each group)
      will receive general anesthesia under invasive monitoring of hemodynamics, and oxygen
      saturation. After anesthesia induction; cannulation of jugular vein and insertion of
      transoesophageal echocardiography and temperature probe will be done. In block group : while
      Patients in supine decubitus position,parasternal area will be scanned using high frequency
      ultrasound linear probe .After identification of ribs with intercostal spaces in between ;the
      fourth intercostal space will be approached via 10 cm block needle targeting the plane
      between pectoralis major and external intercostal muscle under ultrasound guidance after
      which 20 mL of 0.25% bupivacaine with adrenaline 1:400,000 will be administered in increments
      bilaterally. In control group:Sham Block will be done using 20 mL of normal saline 0.9%
      bilaterally .

      Anesthesia will be maintained with sevoflurane inhalational anesthesia and incremental
      cisatracurium and fentanyl for intraoperative muscle relaxation and analgesia respectively.
      Intraoperative anticoagulation will be carried out before revascularization using intravenous
      heparin titrated according to activated clotting time ,which will be reversed after end of
      surgery using protamine sulfate.

      At the end of surgery patients will be sent to post cardiac surgery intensive care unit .
      Postoperative analgesia in the form of intravenous paracetamol one gram will be administered
      on intensive care unit admission then fentanyl based patient controlled analgesia will be
      started . IV tramadol 1mg/kg as second rescue analgesia will be given if visual analogue
      scores are still ≥ 4.
    

Intervention name(s): Ultrasound guided pecto-intercostal Fascial Plane Block using bupivacaine; Ultrasound guided pecto-intercostal Fascial Plane Block using normal saline
Intervention type(s): Procedure; Procedure
Intervention description(s): while Patients in supine decubitus position,parasternal area will be scanned using high frequency ultrasound linear probe .After identification of ribs with intercostal spaces in between ;the fourth intercostal space will be approached via 10 cm block needle targeting the plane between pectoralis major and external intercostal muscle under ultrasound guidance after which 20 mL of 0.25% bupivacaine with adrenaline 1:400,000 will be administered in increments bilaterally.; Sham Block will be done while Patients in supine decubitus position,parasternal area will be scanned using high frequency ultrasound linear probe .After identification of ribs with intercostal spaces in between ;the fourth intercostal space will be approached via 10 cm block needle targeting the plane between pectoralis major and external intercostal muscle under ultrasound guidance after which 20 mL of normal saline 0.9 % will be administered bilaterally.
Intervention MeSH terms: Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention