Intertransverse Process Block to Improve Quality of Recovery After Cardiac Surgery With Sternotomy

Summary

The goal of this clinical trial is to evaluate the efficacy of intertransverse process block (ITPB) in blunting sympathetic response of sternotomy, achieving perioperative opioid-sparing and improving quality of recovery in adult patients undergoing elective cardiac surgery (e.g., coronary artery bypass graft \[CABG\], valve repair/replacement, or combined CABG/valve procedures). The main questions it aims to answer are: 1. To investigate the efficacy of intertransverse process block (ITPB) on quality of recovery after cardiac surgery 2. To investigate the efficacy of ITPB on the sympathetic response on incision, intraoperative and postoperative morphine requirement 3. To investigate the efficacy of ITPB on surgical outcomes including time to weaning off mechanical ventilation, length of ICU/ hospital stay and incidence of neuropathic pain after surgery Researchers will compare patients receiving bilateral ITPB with levobupivacaine to those receiving sham blocks to determine if ITPB reduces CPSP, improves pain control, and decreases opioid consumption.

Timeline

Start

2025-11

Primary completion

2027-11

Completion

2027-11

Publications

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• Results Abdelbaser I, Abourezk AR, Badran A, Abdelfattah M. Bilateral Ultrasound-Guided Mid-Point Transverse Process to Pleura Block for Perioperative Analgesia in Pediatric Cardiac Surgery: A Randomized Controlled Study. J Cardiothorac Vasc Anesth. 2023 Sep;37(9):1726-1733. doi: 10.1053/j.jvca.2023.05.021. Epub 2023 May 14.
• Results Karmakar MK, Sivakumar RK, Sheah K, Pangthipampai P, Lonnqvist PA. The Retro Superior Costotransverse Ligament Space as a New Target for Ultrasound-Guided Intertransverse Process Block: A Report of 2 Cases. A A Pract. 2022 Jul 22;16(7):e01610. doi: 10.1213/XAA.0000000000001610. eCollection 2022 Jul 1.
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• Results Cho TH, Kwon HJ, O J, Cho J, Kim SH, Yang HM. The pathway of injectate spread during thoracic intertransverse process (ITP) block: Micro-computed tomography findings and anatomical evaluations. J Clin Anesth. 2022 May;77:110646. doi: 10.1016/j.jclinane.2022.110646. Epub 2022 Jan 10.
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• Results Wong HMK, Chen PY, Tang GCC, Chiu SLC, Mok LYH, Au SSW, Wong RHL. Deep Parasternal Intercostal Plane Block for Intraoperative Pain Control in Cardiac Surgical Patients for Sternotomy: A Prospective Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2024 Mar;38(3):683-690. doi: 10.1053/j.jvca.2023.11.038. Epub 2023 Nov 30.
• Results Sorenstua M, Zantalis N, Raeder J, Vamnes JS, Leonardsen AL. Spread of local anesthetics after erector spinae plane block: an MRI study in healthy volunteers. Reg Anesth Pain Med. 2023 Feb;48(2):74-79. doi: 10.1136/rapm-2022-104012. Epub 2022 Nov 9.
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• Results Dost B, De Cassai A, Balzani E, Tulgar S, Ahiskalioglu A. Effects of ultrasound-guided regional anesthesia in cardiac surgery: a systematic review and network meta-analysis. BMC Anesthesiol. 2022 Dec 29;22(1):409. doi: 10.1186/s12871-022-01952-7.
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Drugs

Indications

No indication recorded.