Effect of Pectointercostal+ESP Block on Postoperatif Analgesia in Open Heart Surgery

Study Overview
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Brief Summary
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American Society of Anaesthesiologist physical status II-III, aged between 18-65, 60 patients which underwent open cardiac surgery will recruited to this study. These subjects will Ultrasound (USG) guided erector spinae block will perform at T6 level (bilaterally) and pectointercostal plane block at 4-5 intercostal space to the all patient under general anaesthesia. Totally bupivacaine %0.25 2.5 mg/kg will use blocks and 1 ml epinephrin will add to the each local anesthetic solutions. 10 ml %0.25 bupivacain will apply to the chest tube area at the end of surgery. 0.1 microgram/kg morphine will apply intravenously at last 30 minutes of surgery postoperative analgesia to all patients. Postoperative pain assessment will perform with visual analog scale (VAS)

Detailed Description
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American Society of Anaesthesiologist physical status II-III, aged between 18-65, 60 patients which underwent open cardiac surgery will recruited to this study. The patients were randomly allocated into two groups (1:1), via a computer-generated randomization list. Ultrasound (USG) guided erector spinae block will perform at T6 level (bilaterally) and pectointercostal plane block at 4-5 intercostal space to the 30 patients under general anaesthesia in Group block and block will not perform to the control group. Sevoflurane+remifentanil and O2/air combination will perform to the all patients during the surgery. Totally bupivacaine %0.25 2.5 mg/kg will use for blocks and 1 ml epinephrin will add to the each local anesthetic solutions in each side.10 ml %0.25 bupivacain will apply to the chest tube area at the end of surgery. 0.1 microgram/kg morphine intravenously will apply for postoperative analgesia to the all patients at last 30 minutes of surgery. Postoperative pain assessment will perform with visual analog scale (VAS). VAS, morphine consumption and complications will record.Paracetamol 10 mg/kg will repeat to the all patients at the 12th of postoperative period, intravenously. The patient controlled anesthesia with morphin will apply to the all patients. If the VAS score is higher than 4, the rescue analgesic diclofenac Na 75 mg will administer intravenously.

Official Title
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Determining to the Effect of Pectointercostal and ESP Block on Postoperative Analgesia During Open Heart Surgery

Conditions
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Postoperative Pain

Intervention / Treatment
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* Drug: Pectointercostal and ESP block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA II-III patients The patients who will operate for open heart surgery Exclusion Criteria: The patients with Coagulopaty Allergy with local anesthetics infection at the injection sites Obesity (BMI >35kg/m2) Liver and/or kidney failure

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Pectointercostal and ESP<br>Ultrasound (USG) guided erector spinae block will perform at T6 level (bilaterally) and pectointercostal plane block at 4-5 intercostal space to the 30 patients under general anaesthesia in Group block . Sevoflurane+remifentanil and O2/air combination will perform to the all patients during the surgery. Totally bupivacaine %0.25 2.5 mg/kg will use for blocks and 1 ml epinephrin will add to the each local anesthetic solutions in each side.10 ml %0.25 bupivacain will apply to the chest tube area at the end of surgery. | Drug: Pectointercostal and ESP block<br>* Pectointercostal plane block will apply at the 4-5. intercostal space and ESP block will apply athe T6 level bilaterally<br>* Other names: Fascial plane blocks;|
| Placebo Comparator: Control Group<br>Block will not perform to the control group. | Drug: Pectointercostal and ESP block<br>* Pectointercostal plane block will apply at the 4-5. intercostal space and ESP block will apply athe T6 level bilaterally<br>* Other names: Fascial plane blocks;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative analgesia | Visual analog scale (VAS) scores at the postoperative 24th hours. VAS scores define pain scores between 0-10. 0 reflects nopain, 10 reflects the worst pain. | 24 hours in Postanesthesia care unit (PACU) | 
| Morphine consumption | Postoperative morphine consumption during the postoperative 24th hours | 24 hours in Postanesthesia care unit (PACU) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Ekstübation time | Time between end of the surgery and extubation of the patient | First 6 hours at Postanesthesia care unit (PACU) |