Erector Spinae Plane Block Versus Paravertebral Block for Analgesia After Cardiac Surgery (PEPS) (PEPS)
Pain Syndrome, Analgesia, Anesthesia, Local
About this trial
This is an interventional prevention trial for Pain Syndrome focused on measuring Cardiac surgery, Regional analgesia, Pain control
Eligibility Criteria
Inclusion Criteria:
- Undergoing any (scheduled) surgery of the heart (valve or coronary surgery) via a median sternotomy
- Physical status classification (ASA) ≤3
- Patients benefiting from a Social Security scheme or benefiting from it through a third party
Exclusion Criteria:
- Emergency cardiac surgery
- Exclusion criteria related to cardiac surgery with thoracotomy, occurrence of aortic dissection, redo surgery.
- Aortic counterpulsation
- Preoperative cardiogenic shock
- LVEF< 30%
- Severe preoperative chronic or acute renal failure with creatinine clearance less than 30 mL / min according to the MDRD formula
- Pre-existing psychiatric pathology, including addiction to opioids
- Physical or intellectual incapacity to use a PCA
- Known allergy or hypersensitivity to any of the study drugs or analgesia protocol (ropivacaine, paracetamol, opioids)
- Contraindication for performing the paravertebral block and Erector of the spine (ESP): Infection at the site of injection, severe hemostasis disorder, thoracic spinal pathology making the procedure difficult or dangerous to operate
- Obese patient (BMI> 30kg / m2) with poorly perceived thoracic spinous processes.
- vulnerable patients(Pregnant or breastfeeding women, persons benefiting from enhanced protection, namely persons deprived of their liberty by a judicial or administrative decision, adults under legal protection).
Sites / Locations
- Institut Mutualiste montsourisRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Paravertebral Block
Erector Spinae Plane Block
If the patient is randomized to group Paravertebral Block, the anesthesiologist performs TPVB before induction of general anesthesia. The patient is positioned in lateral décubitus position. The anesthetist performs the bilateral paravertebral block with ultrasound identification of the paravertebral space at the T4-T5 level. Slow injection of 0.3 to 0.35 ml / kg of ropivacaine on each side (diluted to 3.75 mg / ml = dilution in a 20 ml syringe with 10 ml of ropivacaine 7.5 mg / ml and 10 ml of NaCl 0.9%) after aspiration test.
If the patient is randomized to group "Erector Spinae Plane Block", the anesthesiologist performs the ESPb block before induction of general anesthesia. The patient is positioned in a right lateral decubitus position. The anesthesiologist performs the erector block of the spine ESP with ultrasound identification at the T4-T5 level (identify the 1st rib on ultrasound then the space T4 to T5). Slow injection of 20 ml of ropivacaine on each side (diluted to 3.75 mg / ml = dilution in a 20 ml syringe with 10 ml of ropivacaine 7.5 mg / ml and 10 ml of 0.9% NaCl) after aspiration test. The patient is then turned in left lateral decubitus position and the contralateral block is performed according to the same procedure.