The Effectiveness of Bilateral Pectoralis Nerve Block in Cardiac Surgery Patients for Managing Postoperative Pain
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Date
2024-01
Journal Title
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Publisher
Society for Health Care & Research Development
Abstract
Background: Effective pain management following cardiac surgery contributes to enhanced recovery and increased mobility. But the coagulation status of the cardiac surgery patients makes neuraxial blocks risky. An alternative to neuraxial blocks for post operative pain management after adult cardiac surgeries is the Pectoralis Nerve (Pecs) block. This innovative technique offers a safe and minimally invasive approach for post operative pain management after adult cardiac surgeries. The objective of the study was to investigate the effectiveness of bilateral pectoralis nerve block in cardiac surgery with regards to enhanced recovery and postoperative pain management. Material & Methods: This was a quasi-experimental study and was conducted in the Department of Anaesthesia, Analgesia and Intensive care medicine of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka, Bangladesh during the period from January 2023 to June 2023. This study involved 40 adult cardiac surgery patients (25-65 years) undergoing coronary artery bypass grafting and valve repair or replacement surgeries via midline sternotomy. They were divided into two groups: Group A received conventional analgesia with intravenous paracetamol 01 gm TDS with continuous intravevous infusion of 1 microgram per kg body weight of fentanyl, and Group B received ultrasound guided bilateral Pectoral Nerve (PEC) block with volume of 0.2 ml per kg body weight of 0.25% bupivacaine with 5 mg of dexamethasone for each interfacial plane . Extubation criteria were used, and data were collected through a questionnaire for visual analogue score and vital parameters such as heart rate , blood pressure, respiratory rate , duration on invasive ventilation at 0 hour, 02 hour, 04 hour, 08 hour and 12 hour post operatively. Results: In total 40 patients from both the groups completed the study. The study found no significant differences in vital parameters between Group A and Group B. Group B showed significantly lower pain scores upto 12 hours post-extubation. Respiratory rate was significantly lower in Group B at six assessment times. No significant differences were observed in hemodynamic variables. Group B had a shorter ICU stay compared to Group A, but no significant difference in hospital stays or duration of ventilator use between the groups. Conclusions: The Pectoral Nerve (Pecs) block is an effective and less invasive and safe procedure for managing postoperative pain and enhancing recovery in adult cardiac surgeries such as CABG, valve repair or replacement surgeries with a medial sternotomy.
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Keywords
Cardiac Surgery, Pectoralis Nerve Block, Pain Management.
Citation
Das Rajat Shuvra, Hoque A.K.M. Faizul, Sultana Ayesha, Hannan Mohammad Abdul, Hassan Mehdi, Karmakar Chandra Shekhar, Jahan A B M Sarwar, Siddique Muhammed Sharif Uddin, Habibullah AKM. The Effectiveness of Bilateral Pectoralis Nerve Block in Cardiac Surgery Patients for Managing Postoperative Pain. Annals of International Medical and Dental Research. 2024 Jan; 10(1): 71-78