Chronic pain is a common complication after cardiothoracic surgery. The prevalence of post-sternoyomy pain syndrome (PSPS) ranges from 33% to 91%. Exact pathogenetic mechanisms for developing chronic pain after sternotomy 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 PSPS .
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 PSPS
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
160
patients will receive bilateral ultrasound-guided pecto-intercostal fascial block using 20 ml of bupivacaine 0.25% for each side.
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.
Benisuef University Hospital
Banī Suwayf, e\EYGPT, Egypt
Total dose of morphine in the first 24 h postoperatively.
total morphine consumed in the first 24 hour
Time frame: 24 hours postoperative
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
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