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Effect of Bilateral Transversus Thoracis Muscle Plane Block in Patients Undergoing Coronary Artery Bypass Graft Surgery. (PARACABS)

12. april 2021 opdateret af: University Hospital, Montpellier

Effect of Bilateral Transversus Thoracis Muscle Plane Block on Postoperative Morphine Consumption in Patients Undergoing Elective On-pump Coronary Artery Bypass Graft Surgery: a Retrospective Study.

Coronary artery bypass graft surgery is the standard surgical treatment for coronary disease. However, there is no consensus on analgesic management in patients undergoing CABG.

The aim of the study is to evualuate efficacy of bilateral transversus thoracis muscle plane (TTMP) block combined with systemic analgesia, compared to systemic analgesia only, in patients undergoing elective on-pump CABG surgery.

Our main hypothesis is that a bilateral TTMP block performed after CABG surgery could reduce morphine consumption during the first 48 hours.

The investigators conducted an age, gender and type of surgery-matched retrospective cohort study in the Montpellier University Hospital (France).

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Observationel

Tilmelding (Faktiske)

100

Kontakter og lokationer

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Studiesteder

  • Frankrig
      • Montpellier, Frankrig, 34295
        • UH Montpellier

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

"TTMP Block" group : fifty consecutive patients who underwent elective on-pump coronary artery bypass graft ± valve surgery after October 2019, with a postoperative analgesic protocol including a bilateral TTMP block, associate with systemic analgesia.

"Systemic Analgesia" group : age, gender and type of surgery-matched patients who underwent elective on-pump coronary artery bypass graft ± valve surgery before September 2019, with a postoperative analgesic protocol based on systemic analgesia only.

Beskrivelse

Inclusion criteria:

  • To be over 18
  • To be scheduled for CABG surgery in the center of the study during the study period.

Exclusion criteria:

  • Chronic pain or opioid use before surgery
  • Recent thoracic regional analgesia (< 1 month)
  • Preoperative dementia or other neurologic or psychiatric disease incompatible with VAS pain scoring.
  • Other technique of regional anesthesia (e.g. thoracic epidural)
  • Opposition to data collection

Secondary exlusion criteria:

  • Postoperative prolonged sedation in ICU (> 12 hours)
  • Postoperative surgical complication requiring surgical revision during the first two days.
  • Opposition to data collection expressed secondarily

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Observationsmodeller: Kohorte
  • Tidsperspektiver: Tilbagevirkende kraft

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Systemic analgesia
Patients received only systemic analgesia : Acetaminophen, Ketoprofen, and Nefopam were administered systematically. Morphine was administered if necessary, according to our institutional pain management protocol.
Bilateral TTMP block + systemic analgesia
Patients received the same protocol of systemic analgesia associated with a bilateral TTMP block performed during the first four hours after ICU admission, before tracheal tube removal.
Procedure: Ultrasound guided Bilateral Transversus Thoracis Muscle Plane block
In the "TTMP block" group, an ultrasounded guided TTMP block was performed by an anesthesiologist, in ICU, before tracheal tube removal. Between the 4th et 5th rib, on each side, 40 ml of Ropivacaine 2 mg/ml, in association with Clonidine, was injected "single-shot" in the tranversus thoracis muscle plane. The targets of local anesthetic were the anterior branches of intercostal nerves from T2 to T6. Dexamethasone 8 mg was injected intravenously.
Andre navne:
  • Transversus Thoracis Muscle Plane Block. Parasternal Block.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
cumulative morphine consumption
Tidsramme: postoperative day 2
cumulative morphine consumption during the first two days. cumulative morphine consumption on postoperative day 0, 1 and 2, including the morphine administered in intensive care unit, and on postoperative day 1 and 2.
postoperative day 2

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Postoperative pain assessed
Tidsramme: postoperative day 0, 1 and 2
Postoperative pain assessed by visual analog scale (VAS) scoring
postoperative day 0, 1 and 2
Postoperative nausea and vomiting
Tidsramme: hospital day 7
Postoperative nausea and vomiting
hospital day 7
Occurrence of prurit
Tidsramme: postoperative day 7
Occurrence of prurit
postoperative day 7
rate of Delirium
Tidsramme: postoperative day 7
rate of Delirium
postoperative day 7
rate of Constipation
Tidsramme: postoperative day 7
rate of Constipation
postoperative day 7
rate of Urinary retention
Tidsramme: until postoperative day 7
rate of Urinary retention
until postoperative day 7
rate of Hypotension
Tidsramme: until postoperative day 7
rate of Hypotension
until postoperative day 7
Pleural drain duration
Tidsramme: day 20
Pleural drain duration
day 20
Urinary catheter duration
Tidsramme: day 20
Urinary catheter duration
day 20
Duration of hospitalization in ICU
Tidsramme: day 20
Duration of hospitalization in ICU
day 20
In-hospital length of stay
Tidsramme: day 20
In-hospital length of stay
day 20
Occurrence of atrial fibrillation
Tidsramme: until postoperative day 7
Occurrence of atrial fibrillation
until postoperative day 7
rate of Pneumonia
Tidsramme: until postoperative day 7
rate of Pneumonia
until postoperative day 7
acute kidney injury
Tidsramme: until postoperative day 7
acute kidney injury
until postoperative day 7

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

University Hospital, Montpellier

Efterforskere

  • Ledende efterforsker: Pierre Sentenac, MD, PhD, UH Montpellier

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. januar 2018

Primær færdiggørelse (Faktiske)

1. december 2019

Studieafslutning (Faktiske)

20. december 2019

Datoer for studieregistrering

Først indsendt

23. marts 2021

Først indsendt, der opfyldte QC-kriterier

12. april 2021

Først opslået (Faktiske)

19. april 2021

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

19. april 2021

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

12. april 2021

Sidst verificeret

1. marts 2021

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • RECHMPL19_0582

Plan for individuelle deltagerdata (IPD)

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Uafklaret

IPD-planbeskrivelse

NC

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