Presternal Bupivacaine Plus Magnesium Sulfate Infusion After Cardiac Surgery
Condition: Pain; Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional

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.

      postoperative pain control will be by 1gm paracetamol / 6 hr, Ketorolac tromethamine 30 mg /
      8:12 hour in control group vs bupivacaine 0.125% plus magnesium sulfate 5% through a single
      catheter after parasternal block in in study group after cardiac surgery.

      The investigators primary outcome is pain scores assessment , the secondary outcomes are
      extubation time, postoperative respiratory parameters, serum cortisol level
    

Intervention name(s): Magnesium Sulfate and Bupivacaine 0.125%
Intervention type(s): Drug
Intervention description(s): Each patient will receive bupivacaine 0.125% with 5% magnesium sulphate by infusion through a catheter used for epidural analgesia, positioned presternal.
Other intervention name(s): study
Intervention MeSH terms: Magnesium Sulfate; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Other
Keywords: Sternotomy , cardiac surgery , pain