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Inadequate pain control after coronary artery bypass graft surgery increases mortality and results in a higher incidence of persistent poststernotomy pain syndrome. Our aim is to assess whether ultrasound-guided parasternal intercostal block (PSIB) or surgeon implied transversus thoracic muscle plane block (TTMPB) would improve the postoperative pain scores and decrease tramadol consumption better after coronary artery bypass graft surgery
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transversus Thoracic Muscle Plane Block (TTMPB) Group | Active Comparator | At the TTMPB group, the block will be performed by the surgeon before the closure of the sternum by visualizing the muscles and identifying them. In the TTMPB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between internal intercostal muscle and transversus thoracic muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space. |
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| Parasternal Intercostal Block (PSIB) Group | Active Comparator | At the PSIB group, the block will be performed by ultrasound guidance after completion of surgery. PSIB Blocks will be performed under ultrasonography guidance using a linear 6 to 13 megahertz ultrasound probe by the anesthesist.In PSIB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between psoas major muscle and external intercostal muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space bilaterally. |
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| Control Group | No Intervention | At the control group, no intervention for pain management will be done. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transversus Thoracic Muscle Plane Block | Procedure | 40 ml %0.375 bupivacaine divided into 4 equal doses will be injected by the surgeon between internal intercostal muscle and transversus thoracis muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative opioid consumption | Tramadol consumption will be assessed by checking patient daily drug order records | Postoperative 24th hour |
| Postoperative opioid consumption | Tramadol consumption will be assessed by checking patient daily drug order records | Postoperative 1st, 4th and 12th hour |
| Measure | Description | Time Frame |
|---|---|---|
| Behavioral Pain Scale | A blinded nurse will assess postoperative pain while they are intubated at the 1st and 4th hour by using 3 subscale Behavioral Pain Scale which ranges from 3 (no pain) to 12 (maximum pain) | postoperative 1st and 4th hour |
| Numeric Rating Scale |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Melike Korkmaz Toker, Assist.Prof | Mugla Sıtkı Kocman University Department of Anesthesiology and Reanimation | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mugla Sıtkı Kocman University Training nad research Hospital | Muğla | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26144912 | Background | Ueshima H, Takeda Y, Ishikawa S, Otake H. RETRACTED: Ultrasound-guided transversus thoracic muscle plane block: a cadaveric study of the spread of injectate. J Clin Anesth. 2015 Dec;27(8):696. doi: 10.1016/j.jclinane.2015.05.013. Epub 2015 Jul 3. No abstract available. |
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via mail
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D002637 | Chest Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| Parasternal Intercostal Plane Block | Procedure | 40 ml %0.375 bupivacaine injection will be performed by ultrasound guidance after completion of surgery between pectoralis major muscle and external intercostal muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space bilaterally by anesthesiologist. |
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A blinded nurse will assess postoperative pain during resting and movement at postoperative 12th and 24th hour by using Numeric rating scale at the extubated patient by using 11-point Numerical Rating Scale which ranges from '0' (means no pain) to '10' (means worst pain imaginable) |
| Postoperative 12th and 24th hour |
| Background |
| de la Torre PA, Garcia PD, Alvarez SL, Miguel FJ, Perez MF. A novel ultrasound-guided block: a promising alternative for breast analgesia. Aesthet Surg J. 2014 Jan 1;34(1):198-200. doi: 10.1177/1090820X13515902. No abstract available. |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |