Background: After cardiac surgery, patients often experience significant pain, primarily due to the median sternotomy or thoracotomy. This pain is usually severe during the first 48 hours, which is the typical duration of their stay in the ICU. Managing this pain effectively is important because it plays a key role in enabling early extubation—usually within 6 to 8 hours after surgery. This approach has become a major advancement in the postoperative ventilatory care of open-heart surgery patients. By optimizing pain control, we can help facilitate early extubation, leading to faster recovery times, decreased length of ICU stay, and better overall outcomes.
Objectives: This study was designed to determine the
efficacy of the parasternal injection of Bupivacaine on postoperative pain for
early extubation in patients undergoing coronary artery bypass grafting (CABG).
Materials and Methods: Patients admitted for elective
primary coronary artery bypass surgery were enrolled in the study. A total of
35 patients were randomized into two groups: Group 1 (Bupivacaine) with 13
patients (37.14%) and Group 2 (Placebo) with 15 patients (42.85%). Standard
anesthetic protocols were followed. Bupivacaine 0.5% at 2 mg per kg was diluted
in a 50 ml syringe with normal saline, and 50 ml of normal saline was used as a
placebo. Identical syringes marked with patient study numbers were delivered to
the operating theaters. Both the surgeon and the anesthetist were blinded to
the content of the solution. The injection was infiltrated into the parasternal
wound at the end of the procedure before placing the sternal wires. The
anesthetist assessed patients in the intensive care unit (ICU) for early
extubation. Pain intensity was measured using a Visual Analogue Scale (VAS) at
the time of extubation.
Results: A total of 35 patients were selected for the study,
but only 28 completed it. Seven patients were dropped out due to prolonged
ventilation (5 patients) and reopening (2 patients). The mean VAS was 1.38±1.19
in the Bupivacaine group and 6.13±2.92 in the Placebo group, with a significant
difference (P<0.001). No rescue pain medication was required in the
Bupivacaine group, while 8 patients (53.3%) in the Placebo group required it.
The mean ventilation time was significantly shorter in the Bupivacaine group
(5.8±1.3 hours) compared to the Placebo group (122±2.8 hours) (P=0.002). Mean
partial oxygen pressure was significantly higher in the Bupivacaine group
(208.23±42.57) compared to the Placebo group (126.40±23.15) (P<0.001).
Conclusion: Parasternal wound infiltration of long-acting
local anesthetic Bupivacaine is an effective method of pain control after
sternotomy. It facilitates early extubation with significant improvements in
oxygenation and VAS scores.
Larger trials including all categories of open-heart
surgery, with more variables such as partial pressure oxygen and carbon dioxide
levels and their mean differences, would lead to yield improved and more
reliable results.
Author (s) Details
Salman Ur Rahman Khan
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Tariq Azam Siddiqi
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Akhtar Husain
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Riffat Tanveer
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi
Arabia.
Saad Badar
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Rafiq Khan
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Iqbal Pathan
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi,
Saudi Arabia.
Munir Afridi
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Ayesha Khan
Department of Cardiac Surgery and Anaesthesia, National Institute of
Cardiovascular Diseases Karachi, Saudi Arabia.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v12/2675
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