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Coronary artery bypass graft surgery is the standard surgical treatment for coronary disease. However, there is no consensus on analgesic management in patients undergoing CABG.
The aim of the study is to evualuate efficacy of bilateral transversus thoracis muscle plane (TTMP) block combined with systemic analgesia, compared to systemic analgesia only, in patients undergoing elective on-pump CABG surgery.
Our main hypothesis is that a bilateral TTMP block performed after CABG surgery could reduce morphine consumption during the first 48 hours.
The investigators conducted an age, gender and type of surgery-matched retrospective cohort study in the Montpellier University Hospital (France).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Systemic analgesia | Patients received only systemic analgesia : Acetaminophen, Ketoprofen, and Nefopam were administered systematically. Morphine was administered if necessary, according to our institutional pain management protocol. | ||
| Bilateral TTMP block + systemic analgesia | Patients received the same protocol of systemic analgesia associated with a bilateral TTMP block performed during the first four hours after ICU admission, before tracheal tube removal. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound guided Bilateral Transversus Thoracis Muscle Plane block | Procedure | In the "TTMP block" group, an ultrasounded guided TTMP block was performed by an anesthesiologist, in ICU, before tracheal tube removal. Between the 4th et 5th rib, on each side, 40 ml of Ropivacaine 2 mg/ml, in association with Clonidine, was injected "single-shot" in the tranversus thoracis muscle plane. The targets of local anesthetic were the anterior branches of intercostal nerves from T2 to T6. Dexamethasone 8 mg was injected intravenously. |
| Measure | Description | Time Frame |
|---|---|---|
| cumulative morphine consumption | cumulative morphine consumption during the first two days. cumulative morphine consumption on postoperative day 0, 1 and 2, including the morphine administered in intensive care unit, and on postoperative day 1 and 2. | postoperative day 2 |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain assessed | Postoperative pain assessed by visual analog scale (VAS) scoring | postoperative day 0, 1 and 2 |
| Postoperative nausea and vomiting | Postoperative nausea and vomiting |
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Inclusion criteria:
Exclusion criteria:
Secondary exlusion criteria:
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"TTMP Block" group : fifty consecutive patients who underwent elective on-pump coronary artery bypass graft ± valve surgery after October 2019, with a postoperative analgesic protocol including a bilateral TTMP block, associate with systemic analgesia.
"Systemic Analgesia" group : age, gender and type of surgery-matched patients who underwent elective on-pump coronary artery bypass graft ± valve surgery before September 2019, with a postoperative analgesic protocol based on systemic analgesia only.
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| Name | Affiliation | Role |
|---|---|---|
| Pierre Sentenac, MD, PhD | UH MONTPELLIER | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Uh Montpellier | Montpellier | 34295 | France |
NC
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|
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| hospital day 7 |
| Occurrence of prurit | Occurrence of prurit | postoperative day 7 |
| rate of Delirium | rate of Delirium | postoperative day 7 |
| rate of Constipation | rate of Constipation | postoperative day 7 |
| rate of Urinary retention | rate of Urinary retention | until postoperative day 7 |
| rate of Hypotension | rate of Hypotension | until postoperative day 7 |
| Pleural drain duration | Pleural drain duration | day 20 |
| Urinary catheter duration | Urinary catheter duration | day 20 |
| Duration of hospitalization in ICU | Duration of hospitalization in ICU | day 20 |
| In-hospital length of stay | In-hospital length of stay | day 20 |
| Occurrence of atrial fibrillation | Occurrence of atrial fibrillation | until postoperative day 7 |
| rate of Pneumonia | rate of Pneumonia | until postoperative day 7 |
| acute kidney injury | acute kidney injury | until postoperative day 7 |
| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| D013001 | Somatoform Disorders |
| D010146 | Pain |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001161 | Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D001523 | Mental Disorders |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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