Efficacy of Ultrasound Guided PIFB Versus Lidocaine Infusion on Postoperative Pain After Thoracotomy

Beni-Suef University138 enrolled

Overview

Chronic pain is a common complication after cardiothoracic surgery. The prevalence of post-thoracotomy pain syndrome (PTPS) ranges from 33% to 91%. Exact pathogenetic mechanisms for developing chronic pain after thoracotomy are unknown. Apart from intraoperative nerve damage and subsequent postoperative neuropathic pain, operation techniques, age, sex, pre-existing pain, genetic and psychosocial factors, severe postoperative pain, and analgesic management are suspected to have an impact on the development of PTPS .

Ultrasound-guided Pecto-intercostal Fascial Block (PIFB) has been advocated by some researchers for cardiac surgery. Pecto-intercostal fascial plane block (PIFB) is a novel, minimally invasive, regional fascial plane block technique. PIFB was first described by de la Torre in patients undergoing breast surgery . PIFB targets the anterior intercostal nerves as they run in the fascial plane between the pectoral and the intercostal muscles and emerge on either side of the sternum. Also, lidocaine, a short-acting local anesthetic, has been proved to have analgesic and anti-inflammatory effects . The application of lidocaine by continuous infusion in the intraoperative period and immediately after the surgery appears to reduce the immediate postoperative pain, and may prevent the PTPS

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

SINGLE

Enrollment

138

Conditions

Cardiac Surgery

Interventions

pecto intercostal fascial block using bupivacaine 0.25%PROCEDURE

patients will receive bilateral ultrasound-guided pecto-intercostal fascial block using 20 ml of bupivacaine 0.25% for each side.

lidocaine infusionDRUG

1.5 mg/kg lidocaine will be administered after induction of anesthesia, then 2mg/kg/h lidocaine will be administered with continuous intravenous infusion until the end of the surgery.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. age between 18 and 75 years. 2. patient scheduled to undergo elective on-pump cardiac surgery with sternotomy. 3. American Society of Anesthesiologists classification of physical status \< IV. Exclusion Criteria: 1. emergency surgery. 2. off-pump surgery. 3. redo surgery. 4. ejection fraction less than 35%. 5. refusal of the patient. 6. known hypersensitivity to LA. 7. chronic opioid use or chronic pain patient. 8. psychiatric problems or communication difficulties. 9. liver insufficiency (defined as a serum bilirubin ≥ 34 μmol/l, albumin ≤ 35 g/dl, INR ≥ 1.7). 10. renal insufficiency (defined as a glomerular filtration rate \< 44 ml/min). 11. obstructive sleep apnea syndrom. 12. coexisting hematologic disorders. 13. pregnancy or breastfeeding.

Outcomes

Primary Outcomes

Total dose of morphine in the first 24 h postoperatively.

total morphine consumed in the first 24 hour

Time frame: 24 hours postoperative

Secondary Outcomes

NRS numerical rating scale.

NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief

Time frame: 24 hours post operative

chronic postoperative pain in 3 months after operation according to numerical rating scale

NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief

Time frame: within 3 months postoperative

Time to rescue analgesic

time from extubation to the time the patiants given analgesia

Time frame: within 24 hour postoperative

time to extubation

from end of surgery to the time of extubation

Time frame: within 24 hour post operative

length of intensive care stay

from end of surgery to the time of discharging to the surgical word

Time frame: within one week