Regional Blocks for CABG Artery Bypass Graft Surgery

Study Overview
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Brief Summary
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Pain control after CABG is an essential step to guard against postoperative complications such as lung atelectasis. This major step can be achieved by opioids or regional blocks. Regional blocks allow better pain control and avoid side effects of opioid based pain control

Detailed Description
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Ultrasound guided External oblique intercostal plane block and pectointercostal plane block for perioperative analgesia in coronary artery bypass graft surgery: Prospective randomized controlled study Introduction: Pain control is a vital component to achieve enhanced recovery after cardiac surgery. Effective postoperative pain control will reduce the incidence of numerous postoperative complications, can facilitate early mobilization and may result in earlier recovery. Pain control is historically achieved by the administration of opioids, which is associated with well-documented side effects, such as sedation, respiratory depression, pruritus, hallucinations and postoperative nausea and vomiting (PONV). Enhanced recovery following coronary artery bypass grafting (CABG) has gained attention even though there is limited evidence on the efficacy and effectiveness of existing analgesic techniques. The external oblique intercostal plane and pectointercostal plane blocks are a new modality that will be used to improve pain-related outcomes after CABG surgery, and has not been extensively investigated. Therefore, we will test the hypothesis that external oblique intercostal plane and pectointercostal plane blocks can reduce cumulative opioid consumption for the patients undergoing CABG surgery when added to conventional multi-model intravenous analgesic technique. The aim of this prospective comparative investigation is to assess the impact of external oblique intercostal plane and pectointercostal plane blocks in a multimodal perioperative analgesic regimen and any related side effects in patients undergoing CABG surgery. Patients and Methods: A prospective study will be carried out in Alexandria Main University Hospital on 120 American society of anaesthesiologists (ASA) II, III physical status aged 40-60 years scheduled for major upper abdominal surgery, after approval of the Medical Ethics Committee and an informed written consent. Patients will be categorized into two equal groups, group I (60) will be subjected to bilateral external oblique intercostal plane and pectointercostal plane blocks and group II (60) will be subjected to fentanyl infusion at a rate of 1μg/kg/h. During the patient stay in the ICU, total analgesic requirements will be measured in both groups. Also, sedation level, duration of intubation and length of ICU stay will be assessed.

Official Title
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Ultrasound Guided External Oblique Intercostal Plane Block and Pectointercostal Plane Block for Perioperative Analgesia in Coronary Artery Bypass Graft Surgery: Prospective Randomized Controlled Study

Conditions
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Analgesia After Coronary Artery Bypass Graft Surgery

Intervention / Treatment
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* Procedure: Pectointercostal plane block and external oblique intercostal plane block
* Procedure: Fentanyl infusion


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients undergoing CABG surgery Exclusion Criteria: BMI above 40 allergy for drugs used complicated cases patient refusal chronic opioid use cognitive dysfunction chronic kidney disease
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: Block group<br>Patients will be subjected to bilateral external oblique intercostal plane and pectointercostal plane blocks | Procedure: Pectointercostal plane block and external oblique intercostal plane block<br>* Patients will be subjected to bilateral external oblique intercostal plane and pectointercostal plane blocks<br>|
| Active Comparator: Opioid group<br>Patients will be subjected to fentanyl infusion at a rate of 1μg/kg/h | Procedure: Fentanyl infusion<br>* Patients will be subjected to fentanyl infusion at a rate of 1μg/kg/h<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative fentanyl requirements for 24 hours | Visual analogue score will be measured every 2 hours | 24 hours postoperatively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue score | Visual analogue score will be measured every 2 hours | 24 hours postoperatively | 
| Rescue analgesia | 0.5 microgram/kg fentanyl will be given if visual analogue score more than 4 | 24 hours postoperatively | 
| Side effects | Any side effect related to fentanyl or block technique will be detected and treated properly | 24 hours postoperatively |