Studies of Application of Combined General Anesthesia and Bilateral TPVB in OPCABG

Xiangya Hospital of Central South University60 enrolled

Overview

This study intends to compare the combination of general anesthesia (GA) and single-shot bilateral thoracic paravertebral block (TPVB) by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery ( OPCAB) with traditional general anesthesia (GA) perioperative management of patients, committed to reducing patient's physical and psychological stress by surgical trauma, achieve the purpose of fast recovery, in order to establish an more effective perioperative management during off-pump coronary artery bypass surgery, improve patients' satisfaction and to accelerate postoperative rehabilitation safely. Patients included in the study (approximately 60 cases) will be randomly divided into PVB(T2/3+T5/6)+GA experimental group (A), PVB(T3/4)+GA experimental group (B)the conventional GA control group (C). All groups received the preoperative preparation, anesthesia and postoperative treatment according to the traditional manner, the group A of patients has been received bilateral thoracic paravertebral block (TPVB T2/3+T5/6) by ropivacaine(0.3%,10ml\*4), group B will received bilateral thoracic paravertebral block (TPVB T3/4)by ropivacaine(0.3%,20ml\*2).,while the group C will received the conventional general anesthesia management without block.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Interventions

bilateral thoracic paravertebral blockPROCEDURE

group A under TPVB((TPVB T2/3+T5/6) by ropivacaine(0.3%,10ml\*4)program

Transesophageal Echocardiography（TEE）DEVICE

1. Apply Transesophageal Echocardiography（TEE）after anesthesia induction and draw 400ml autologous blood (Haemonetics®)used for the postoperative transfusion; 2. Goal-directed fluid management

Lung protection measure during the surgery（Dräger Primus）DEVICE

Protective ventilation strategy(Low tidal volume about 6\~7ml/kg, joint use of PEEP)

Anesthesia drugs during the surgeryDRUG

1. Bilateral thoracic paravertebral block before induction of anesthesia; 2. Fast channel anesthesia • Induction use Sufentanil 0.5\~1ug/kg, Vecuronium for Injection 0.15mg/kg and Etomidate 0.2\~0.6mg/kg; ②. Maintain use Sufentanil Hydrochloride for Injection 0.01\~0.04ug/kg•min, Sevoflurane 0.5\~1.5MAC（minimum alveolar concentration） and Infusing Dexmedetomidine which load dose 0.5μg/kg in 10min then changed into 0.5-1.0μg/kg•h,Vecuronium 0.06\~0.12mg/kg•h; ③. Intravenous hydromorphone Hydrochloride Injection 0.15mg/kg before surgery over.

thoracic paravertebral blockPROCEDURE

group B under(TPVB T3/4)by ropivacaine(0.3%,20ml\*2)program

Eligibility

Sex: ALLMin age: 35 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Heart function grade II - III (Using the cardiac function classification method formulated by American Heart Disease Institute) * The in - hospital was treated with off pump coronary artery bypass grafting（CABG) operation and general anesthesia. * Had a good cognition, and signed the informed consent. * Aged between 35 and 80. * The age, clinical examination and other generally situation of the two groups of patients had no statistical significance. no merger of valvular disease left ventricular ejection fraction \> 40%, do not need intraaortic balloon counterpulsation support, without spinal deformity, no vertebral side clearance space-occupying lesions Exclusion Criteria: * Combined with other blood coagulation dysfunction, serious brain, liver and kidney dysfunction, endocrine system diseases and serious infectious disease. * Patients with severe mental disorders cannot cooperate with the treatment. * Emergency operation * Have taboo of Echocardiography and pulmonary catheterization by echocardiography. * Allergic to Local anesthetics drug. * Suspected or had alcohol, drug abuse history. * Spinal or paravertebral lesions.