Efficacy of Erector Spinae Plane Block Analgesia After Off Pump Cardiac Surgery

Study Overview
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Brief Summary
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In this study the investigators will investigate the efficacy of ESPB as a part of Enhanced recovery after surgery on postoperative analgesia and recovery criteria after off pump cardiac surgery.

Detailed Description
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General anaesthesia will be induced by 0.05 mg/kg midazolam, 3 µg/kg fentanyl, 1-2mg/kg propofol, and 0.5mg/kg of Atracurium. After induction, bilateral erector spinae plane block will be performed in the block group. Intraoperative analgesia will be achieved by fentanyl boluses of 0.5-to-1 µg/kg titrated according to haemodynamic parameters. Postoperative analgesia will be managed by paracetamol 1000 mg /6hours and morphine 1-2mg boluses when pain score ≥4 1 to 2 mg to be repeated every 5 minutes if needed.

Official Title
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Efficacy of Erector Spinae Plane Block on Postoperative Analgesia and Recovery After Off Pump Cardiac Surgery: A Randomised Trial

Conditions
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Postoperative Pain

Intervention / Treatment
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* Procedure: Erector spinae block
* Drug: Fentanyl


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18-70 years ejection fraction of > 45% undergoing elective off-pump cardiopulmonary bypass surgery Exclusion Criteria: vertebral anomalies intra-aortic balloon pump in the preoperative period acute myocardial infarction local infection at the site of block allergy to the local anesthetic used morbid obesity, psychiatric disorders, neurologic deficits, alcohol and chronic opioid abuse, and patients with bleeding diathesis.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 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: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Erector spinae block group<br>the patients will be administered bilateral Erector spinae block with 20 ml of 0.25 % bupivacaine | Procedure: Erector spinae block<br>* After induction, the patients will be administered bilateral Erector spinae block with 20 ml of 0.25 % bupivacaine<br>Drug: Fentanyl<br>* fentanyl boluses of 0.5-to-1 µg/kg titrated according to haemodynamic parameters.<br>|
| Other: control group<br>no block will be done but only IV analgesia. | Drug: Fentanyl<br>* fentanyl boluses of 0.5-to-1 µg/kg titrated according to haemodynamic parameters.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total intraoperative and postoperative opioid consumption | Microgram and mg | 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity at rest and movement | numerical rating score from zero to ten ( 0=no pain, 10 =severe pain ) | 48 hours | 
| time to first rescue analgesia | minutes | 24hous | 
| Duration of mechanical ventilation | hours | 24 hours | 
| time to extubation | min | 24hours | 
| time to ambulation | hours | 24hours | 
| time to oral intake | hours | 48 hours | 
| time of chest drain removal | hours | 5 days | 
| time of intensive care unit stay | hours | one week | 
| The heart rate | Beats per minutes | 48 hours | 
| mean arterial blood pressure | mmHg | 48 hours |