Surgery-induced pain reveals its own metabolic and inflammatory responses, resulting in a further increase in noxious pathways that are already occurring. Even though it is difficult to distinguish whether the metabolic and inflammatory responses are pain-induced or surgical-induced, it is clear that pain can cause a response. This study aims to investigate the effects of erector spinae plane block on surgery-related stress response with enhanced recovery after cardiac surgery protocol.
The Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) program includes a perioperative multimodal, opioid-sparing pain management plan as an essential component of any comprehensive program. A multimodal pain management plan is nonopioid systemic analgesic agents, regional and local anesthetic techniques, and judicious use of opioids. This study aims to examine inflammatory and hematological parameters in patients who underwent cardiac surgery with ERAS, with and without preoperative bilateral erector spinae plane block (ESP). For this purpose, the presence of an obstacle ESP block application in the preoperative period will be investigated in patients who are prepared for cardiac surgery according to ERAS principles, and the patient's group will be determined accordingly. An analgesia protocol that does not include a regional technique will be applied to the patient in cases such as the patient's refusal to allow preoperative block and the presence of a situation that does not allow blockage in the block area. The perioperative characteristics of ERAS patients with and without ESP block will be examined, intraoperative lactate, and preop-postoperative hemogram-albumin-C reactive protein parameters will be recorded. ERAS patients with ESP block: After preparation in accordance with the ERAS protocol, ultrasound-guided bilateral ESP block will be performed with 20 ml of 0.025% bupivacaine at T5-7 levels in patients taken to the operating room in the preoperative period, and will be administered intraoperative low-dose remifentanil infusion and sevoflurane anesthesia. ERAS patients without ESP block: After preparation according to the ERAS protocol, patients will be administered lidocaine, ketamine, paracetamol, and intraoperative low-dose remifentanil infusion and sevoflurane anesthesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
Preoperative ultrasound-guided bilateral erector spinae plane block with 20 ml 0.025% bupivacaine.
Ankara City Hospital
Ankara, Select State/Province, Turkey (Türkiye)
Basal measurements- after anesthesia induction
After induction of anesthesia, blood gas analysis will be performed and lactate level (mmol/L) will be recorded.
Time frame: After anesthesia induction, an average of 5 minutes
Basal measurements- after anesthesia induction
After induction of anesthesia, blood gas analysis will be performed and hemoglobin level (g/dL) will be recorded.
Time frame: After anesthesia induction, an average of 5 minutes
Second measurements- after cardiopulmonary bypass initiation
After cardiopulmonary bypass initiation, blood gas analysis will be performed and lactate level (mmol/L) will be recorded.
Time frame: After cardiopulmonary bypass inititation, an average of 5 minutes
Second measurements- after cardiopulmonary bypass initiation
After cardiopulmonary bypass initiation, blood gas analysis will be performed and hemoglobin level (g/dL) will be recorded.
Time frame: After cardiopulmonary bypass inititation, an average of 5 minutes
Third measurements- during cardiopulmonary bypass, at lowest temperature
During cardiopulmonary bypass, at lowest temperature, blood gas analysis will be performed and lactate level (mmol/L) will be recorded.
Time frame: During cardiopulmonary bypass, an average of 10 minutes
Third measurements- during cardiopulmonary bypass, at lowest temperature
During cardiopulmonary bypass, at lowest temperature, blood gas analysis will be performed and hemoglobin level (g/dL) will be recorded.
Time frame: During cardiopulmonary bypass, an average of 10 minutes
Fourth measurements- end of cardiopulmonary bypass
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SUPPORTIVE_CARE
Masking
NONE
Enrollment
70
At the end of cardiopulmonary bypass, blood gas analysis will be performed and lactate level (mmol/L) will be recorded.
Time frame: At the end of cardiopulmonary bypass, an average of 10 minutes
Fourth measurements- end of cardiopulmonary bypass
At the end of cardiopulmonary bypass, blood gas analysis will be performed and hemoglobin level (g(dL) will be recorded.
Time frame: At the end of cardiopulmonary bypass, an average of 10 minutes
Fifth measurements- end of surgery
At the end of surgery, blood gas analysis will be performed and lactate level (mmol/L) will be recorded.
Time frame: At the end of surgery, an average of 20 minutes
Fifth measurements- end of surgery
At the end of surgery, blood gas analysis will be performed and hemoglobin level (g/dL) will be recorded.
Time frame: At the end of surgery, an average of 20 minutes
Preoperative complete blood count
Preoperative complete blood count will be evaluated and recorded.
Time frame: The day before surgery, 24 hours
Preoperative albumin
Preoperative albumin levels will be evaluated and recorded.
Time frame: The day before surgery, 24 hours
Postoperative C reactive protein
Postoperative C reactive protein levels will be evaluated and recorded.
Time frame: 6 hours after surgery
Postoperative complete blood count
Postoperative complete blood count will be evaluated and recorded.
Time frame: 6 hours after surgery
Postoperative albumin
Postoperative albumin levels will be evaluated and recorded.
Time frame: 6 hours after surgery