This is a randomized, double-blind, controlled clinical trial is to evaluate the duration of efficacy of parasternal blocks with the use of local anesthetic adjuncts for analgesia after coronary artery bypass grafting surgery.
This study will randomize patients to either standard pain control protocols or parasternal blocks after coronary artery bypass grafting-only surgery. This study will specifically examine the effectiveness and duration of analgesia of parasternal blocks with local anesthetic adjuncts, Dexamethasone 10mg and Dexmedetomidine 50mcg, added to the local anesthetic mixture
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
60
Parasternal block with Bupivacaine 0.25% + Epinephrine 1:200,000 x 60cc + Dexamethasone 5mg and Dexmedetomidine 50mcg
All standard management of postoperative pain, as per local protocols
Jewish General Hospital
Montreal, Quebec, Canada
Pain with inspirometry at 24 hours after surgery
Numerical Rating Scale (NRS) pain score from the sternotomy site during inspirometry. The VAS score is a scale from 0 to 10 where 0 is equivalent to "no pain" and 10 is equal to "the worst imaginable pain"
Time frame: 24 hours after surgery
Opioid consumption
Amount of opioid administered (mg of Dilaudid)
Time frame: 12, 24 and 48 hours after surgery
Amount of rescue analgesia administered
Amount of ketorolac or ketamine administered
Time frame: Total in the first 48 hours after surgery
Pain score at rest
Numerical Rating Scale (NRS) pain score from the sternotomy site during inspirometry. The VAS score is a scale from 0 to 10 where 0 is equivalent to "no pain" and 10 is equal to "the worst imaginable pain"
Time frame: 12, 24 and 48 hours after surgery
Pain score with inspirometry
Numerical Rating Scale (NRS) pain score from the sternotomy site during inspirometry. The VAS score is a scale from 0 to 10 where 0 is equivalent to "no pain" and 10 is equal to "the worst imaginable pain"
Time frame: 12 and 48 hours after surgery
Intensive Care Unit (ICU) Length of Stay
Time spent in the intensive care unit after surgery (days)
Time frame: From surgery until discharge from the ICU, assessed from the date of surgery up until 6 months after the completion of the study
Hospital Length of Stay
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Time spent in the hospital after surgery (days)
Time frame: From the date of surgery up until discharge from hospital, followed from the date of surgery up until 6 months after the completion of the study
Inspirometry
Volume inspired on inspirometry
Time frame: 24 hours after surgery
Patient satisfaction with pain control
0 "extremely unsatisfied" to 10 "extremely satisfied"
Time frame: at 48 hours after surgery
Mobilization
Time from ICU arrival to the first mobilization to a chair
Time frame: From ICU arrival until first mobilization (approximately first 48 hours postoperatively)
Ambulation
Time from ICU arrival to the first mobilization to a chair
Time frame: From ICU arrival until first ambulation (approximately first 72 hours postoperatively)