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Year : 2015  |  Volume : 2  |  Issue : 4  |  Page : 96-100

Continuous regional local anesthetic infusion for pain control after median sternotomy

1 Department of Anaesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
2 Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Correspondence Address:
Eslam N Nada
Moahada Street, El Hedaya Tower, El Sharkia, Zagazig, 44519
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2356-9115.178899

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Background The use of continuous wound irrigation by local anesthetics has attracted considerable attention in many surgical specialties, including cardiac surgeries. The aim of this study was to evaluate the postoperative analgesic effect of local anesthetic infusion into the wound resulting from a standard median sternotomy using a catheter of surgical vacuum device of size 12 Fr in patients after coronary artery bypass graft operation in comparison with intravenous analgesia. Patients and methods This is a randomized clinical study conducted in Zagazig University Hospital. After obtaining approval and written consent, 40 patients who were enrolled for coronary artery bypass graft with standard median sternotomy incision were divided into two groups: in group 1 postoperative pain was managed according to the ordinary protocol of the cardiac ICU - that is, intravenous pethidine 50 mg/12 h and 1 g paracetamol/8 h with supplemental doses of 25 mg pethidine on patients' demand, with the total daily dose of pethidine not exceeding 400 mg. In group 2 postoperative pain was managed by continuous regional local anesthetic infusion of bupivacaine 0.25% at a rate of 4 ml/h for 48 h by means of a catheter inserted over the sternum. The following data were collected: the amount and time of analgesia given to the patients, data from pain assessment carried out after extubation and every 4 h until discharge from the ICU, heart rate, systolic blood pressure, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1 ) and FEV 1 /FVC ratio, time of weaning from the mechanical ventilator, and time of discharge from the ICU and discharge from hospital. Results There was significant statistical difference between the two groups regarding all of the collected data, except demographic data, FEV 1 /FVC ratio, and length of stay in the ICU, which was 48 h for all patients in both groups. Conclusion Continuous local anesthetic infusion after standard median sternotomy resulted in lower pain scores, less need for narcotics, rapid weaning from the mechanical ventilation, better respiratory functions, and shorter hospital length of stay.

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