Influence of Superficial Parasternal Intercostal Plane Block (SPIPB) on Internal Thoracic Artery (ITA) Caliber and Surgical Harvesting Efficiency in Coronary Artery Bypass Grafting (CABG)
Parasternal intercostal blocks (PSB) represent a newer approach to post-sternotomy pain management. Studies suggest their effectiveness in providing postoperative analgesia , with a significant advantage being their suitability even during concurrent antiplatelet or anticoagulant therapy.In addition to its sympatholytic effects cause vasodilatation , a reduction in vascular resistance, and an increase in local blood flow . The effects are maintained up to the early postoperative period .
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
50
Superficial parasternal block will be given to assess diameter of IMA by using US to assess caliber and ease of harvesting.
Faculty of Medicine ,Ain Shams University
Cairo, Cairo Governorate, Egypt
Change in Internal Thoracic Artery (ITA) Diameter
Change in the diameter of the Internal Thoracic Artery (ITA) measured in millimeters (mm) after SPIPB administration.
Time frame: Measured 15 minutes after the SPIPB injection by intraoperative ultrasound.
Change in Internal Thoracic Artery (ITA) Cross-Sectional Area
Change in the cross-sectional area of the Internal Thoracic Artery (ITA) measured in square millimeters (mm²) after SPIPB administration.
Time frame: Measured 15 minutes after the SPIPB injection by Intraoperative ultrasound.
Time Required for ITA Harvesting
Total time in minutes (min) required to harvest the Internal Thoracic Artery.
Time frame: Measured during the surgical harvesting procedure.
Technical Difficulty of ITA Harvesting
Assessed using a Technical Difficulty Scale. The scale ranges from 1 (Very Easy) to 5 (Very Difficult), where a higher score indicates a worse outcome (more difficult harvesting).
Time frame: Assessed by the surgeon immediately after the harvesting procedure.
Postoperative Pain Score
Postoperative pain assessed using the Visual Analog Scale (VAS) for pain. The scale ranges from 0 mm (No Pain) to 100 mm (Worst Possible Pain), where a higher score indicates a worse outcome.
Time frame: Measured at 24 hours postoperatively.
Postoperative Opioid Consumption
Total postoperative opioid consumption, measured in Morphine Milligram Equivalents (MME).
Time frame: Measured over the first 24 hours postoperatively.
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Intraoperative Hemodynamic Stability
Incidence of significant hemodynamic instability (e.g., episodes of hypotension or hypertension requiring intervention).
Time frame: Measured during the intraoperative period.