Abstract
Background and Objective:Pain control during surgery in order to cause analgesia and reduce the somatic and autonomic response may decrease the morbidity. Intrapleural catheter embedding during surgery under direct vision of surgeon is safe and easy and without potential risk of thoracic epidural block. The aim of this study was to investigate the effect of bilateral intrapleural infusion of lidocaine with fentanyl versus only lidocaine in relieving pain after coronary artery bypass surgery.Methods:In this prospective randomized double blind clinical trial,130 adult patients undergoing elective CABG with age range of 20 to 60 years were divided into two groups receiving either lidocaine and fentanyl (group A) or lidocaine (group B). The analgesia was evaluated every two hours in all intubated and non-intubated patients using Visual analog scale (VAS) and data were analyzed using SPSS software package.Results:Of all patients, 67 (51.5%) were males and 63 (48.5%) were females. The average age of subjects was 53.49 ± 5.099 years. Mean pain score six hours after the surgery was statistically different between the groups at all times.Conclusion:The pain in patients receiving combination of lidocaine and fentanyl is less than patients receiving only lidocaine.
Highlights
Pain causes severe autonomic and physiological responses which can be very dangerous in patients with ischemic heart disease.[1]
Due to different techniques of coronary artery bypass graft surgery (CABG) which differ the location and severity of pain in this group and as to the best of our knowledge, there is no study about pain control levels using intrapleural block after CABG, we decided to conduct a study to compare the effect of intrapleural lidocaine and fentanyl with only lidocaine in reducing pain after CABG. This prospective randomized double blind clinical trial study was conducted in Tabriz Shahid Madani Hospital, after obtaining approval of the university ethics committee and written consent from patients
One hundred thirty adult patients between the age of 20 to 60 years and undergoing elective CABG having 3 to 6 hours operation time were divided into two groups
Summary
Pain causes severe autonomic and physiological responses which can be very dangerous in patients with ischemic heart disease.[1] Pain control during surgery in order to cause analgesia and reduce the somatic and autonomic response decreases the morbidity.[2] A variety of strategies including spinal anesthesia, intercostal nerve block, systemic opioids, and non-steroidal anti-inflammatory drugs and alpha-2 agonist are used to control pain.[3] There is debate about the effectiveness of various types of preventive analgesia; but the combination of local anesthesia and general anesthesia may improve pain control after surgery.[4] An effective analgesia protocol improves lung function and allows physiotherapy to start sooner after the surgery.[5]. The use of systemic opioids can cause respiratory depression and bowel dysfunction.[3] Spinal anesthesia is the most effective way to control pain after thoracotomy, but carries a significant risk of epidural hematoma and respiratory depression.[6] The disadvantages of peripheral nerve block includes high concentrations of plasma level of drug due to high blood feeding around intercostal nerves, patients discomfort and prolonged neuralgia.[7]. Conclusion: The pain in patients receiving combination of lidocaine and fentanyl is less than patients receiving only lidocaine
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