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This randomized controlled trial evaluates the effectiveness of different postoperative analgesic strategies in patients undergoing coronary artery bypass graft (CABG) surgery. Patients were allocated into three groups receiving either conventional analgesia alone, parasternal block in addition to conventional analgesia, or combined parasternal and adductor canal blocks with conventional analgesia. The study aims to compare postoperative pain scores, opioid consumption, and recovery outcomes among the groups in order to determine whether the addition of regional anesthesia techniques, particularly the combined block approach, provides superior analgesia and enhances postoperative recovery following CABG surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional analgesia | Active Comparator |
| |
| Parasternal block | Active Comparator |
| |
| Parasternal block + Adductor canal block | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| parasternal block | Procedure | Ultrasound-guided parasternal block was performed bilaterally after induction of general anesthesia in patients undergoing coronary artery bypass graft surgery. Following aseptic skin preparation, a high-frequency linear ultrasound probe was placed parallel to the sternum to identify the parasternal intercostal plane. A block needle was advanced under ultrasound guidance, and local anesthetic was injected into the interfascial plane adjacent to the sternum to provide anterior thoracic wall analgesia. The procedure was performed according to institutional standardized block protocols. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative opioid consumption | Postoperative opioid consumption will be assessed as the cumulative morphine dose administered via intravenous patient-controlled analgesia (PCA). Morphine consumption will be recorded at predefined postoperative time points, and total morphine consumption will be calculated at 72 hours after surgery. | At postoperative 0,1, 2, 4, 8, 12, 24, 48, and 72 hours; total morphine consumption at 72 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain scores assessed using the Numeric Rating Scale (NRS) | Postoperative pain intensity will be evaluated using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst imaginable pain. Pain scores will be recorded at predefined postoperative time points up to 72 hours after surgery. | At postoperative 0, 1, 2, 4, 8, 12, 24, 48, and 72 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Merve Sena baytar, MD | Contact | +90 506 827 05 30 | drmsbaytar@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zonguladk Bulent ecevit University | Zonguldak | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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|
| Parasternal block + Adductor canal block | Procedure | In addition to conventional analgesia, patients received ultrasound-guided bilateral parasternal block and adductor canal block after induction of general anesthesia. The parasternal block was performed by injecting local anesthetic into the interfascial plane adjacent to the sternum under ultrasound guidance to provide anterior thoracic wall analgesia. The adductor canal block was performed under ultrasound guidance by depositing local anesthetic within the adductor canal to provide analgesia at the saphenous vein graft harvesting site. All procedures were performed according to standardized institutional protocols. |
|
| conventional analgesic regimen | Other | Patients received standard postoperative analgesia consisting of intravenous patient-controlled analgesia (PCA) with morphine following coronary artery bypass graft surgery. The PCA device was initiated in the postoperative period according to institutional analgesia protocols, allowing patient-administered morphine dosing for pain control. Additional rescue analgesics were administered when clinically indicated. |
|
| Quality of Recovery-15 (QoR-15) score | Postoperative recovery quality will be assessed using the Quality of Recovery-15 (QoR-15) questionnaire at 24 and 72 hours after surgery. The QoR-15 is a validated patient-reported outcome measure evaluating multiple domains of postoperative recovery, with higher scores indicating better recovery quality. | At postoperative 24 and 72 hours |
| Postoperative nausea and vomiting and antiemetic consumption | Postoperative nausea and vomiting (PONV) will be evaluated at predefined postoperative time points using a standardized nausea-vomiting scoring system. The requirement for rescue antiemetic treatment and the total amount of antiemetic medication administered during the first 72 postoperative hours will also be recorded. | At postoperative 0, 1, 2, 4, 8, 12, 24, 48, and 72 hours |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009422 | Nervous System Diseases |