Pectointercostal Fascial Plane Block Versus Transversus Thoracic Plane Block In Adult Cardiac Surgery Patients

Study Overview
=================
Brief Summary
-----------------
The study will be designed to compare the analgesic effect of ultrasound-guided pectointercostal fascial plane block versus tansversus thoracic plane block in adult cardiac surgery.

Detailed Description
-----------------
A prospective study will be carried out in Alexandria Main University Hospitals on 60 adult patients planned for elective cardiac surgery, after approval of the Ethical Committee of Faculty of Medicine, Alexandria, and having an informed written consent taken from patients included in the study. Patients will be categorized into two equal groups; group P (n=30)) will receive ultrasound-guided pectointercostal fascial plane block and group T (n=30) will receive ultrasound-guided transversus thoracic plane block. All patients will receive the ultrasound-guided block after induction of anesthesia and an equal booster dose of the same block before extubation in the ICU. Patients in both groups will also receive an ultrasound-guided bilateral serratus anterior plane block before extubation.

Official Title
-----------------
Ultrasound Guided Pectointercostal Fascial Plane Block Versus Transversus Thoracic Plane Block In Adult Cardiac Surgery Patients: A Comparative Study

Conditions
-----------------
Pain, Post Operative

Intervention / Treatment
-----------------
* Procedure: ultrasound guided regional block


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult patient. Elective cardiac surgery. Exclusion Criteria: Refusal to participate. Redo or urgent cardiac surgery. Local infection of the skin at the site of needle puncture. Allergy to bupivacaine. Coagulation disorders. Clinically significant liver or kidney disease, heart failure, moderate to severe pulmonary hypertension. when extubation is intentionally planned to be delayed

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Pectointercostal Group (n=30)<br>They will receive ultrasound-guided pectointercostal fascial block after induction of anesthesia with equal dose before extubation in the intensive care. | Procedure: ultrasound guided regional block<br>* Bupivacaine injection by the use of ultrasound in the pectointercostal fascial plane in one group and in the trasversus thoracic plane in the other group.<br>* Other names: ultrasound guided nerve block;|
| Active Comparator: Transversus thoracic Group (n=30)<br>They will receive ultrasound-guided ultrasound-guided transversus thoracic plane block after induction of anesthesia with equal dose before extubation in the intensive care. | Procedure: ultrasound guided regional block<br>* Bupivacaine injection by the use of ultrasound in the pectointercostal fascial plane in one group and in the trasversus thoracic plane in the other group.<br>* Other names: ultrasound guided nerve block;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the analgesic effectiveness of the two blocks on midline sternotomy pain, | Postoperative pain evaluation after extubation will be done using the Visual Analogue Scale (VAS). a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between 0 no pain and 10 worst pain. | from end of surgery till discharge from ICU (96 hours) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pulmonary complications | atelectasis and pneumonia | from end of surgery till discharge from ICU (96 hours) | 
| length of stay in ICU | days from admission till discharge from ICU | average 4 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Ultrasound, pectointercostal, Cardiac surgery