Parasternal Block Combined With Rectus Sheath Block for Cardiac Surgery Under Sternotomy (PARARECTUS)

Ultrasound Guided Parasternal Block Combined With Rectus Sheath Block for Cardiac Surgery Under Sternotomy: A Randomized Controlled Trial

The aim of this randomized controlled trial is to examine the effect of ultrasound guided bilateral Parasternal Nerve Block combined with rectus sheath block on preoperative analgesia, opioid consumption and respiratory function in patients undergoing cardiac surgery via sternotomy. Half of participants will receive General Anesthesia combined with bilateral parasternal block and rectus sheath block while the other half receive General Anesthesia combined with bilateral parasternal block and infiltration of drainage exits sites with local anesthetic (without performing rectus sheath block)

Patients will receive General Anesthesia combined with bilateral parasternal block and rectus sheath block

Patients will receive General Anesthesia combined with bilateral parasternal block and infiltration of drainage exits sites with local anesthetic

After induction of general anesthesia, an ultrasound-guided Parasternal Block will be performed with 20 mL of ropivacaine 0.5 % per side.

At the end of surgery, a local infiltration of drainage exit sites will be performed with 10 mL of ropivacaine 0.25% per side

At the end of surgery, a rectus sheath block will be performed with 10 mL of ropivacaine 0.25% per side.

A numerical rating scale (NRS) from 0 (no pain) to 10 (worst imaginable pain) will be used to evaluate pain at rest during 24 hours after surgery

A numerical rating scale (NRS) from 0 (no pain) to 10 (worst imaginable pain) during movement will be used to evaluate pain at rest during 24 hours after surgery

Total of intravenous morphine (expressed in milligrams) administered during the first 24 hours after surgery

Respiratory performance is assessed preoperatively and postoperatively (at extubation) by the number of balls raised during inspiration with the TRI-FLOW spirometer

Any complications or side effects of the blocks, such as local infection, intravascular injection of local anesthetics and immediate systemic toxicity. Moreover, incidence of nausea, vomiting and postoperative respiratory complications will be recorded.

Inclusion Criteria: Patients undergoing elective cardiac surgery under median sternotomy Age >= 18 years American Society of Anesthesiologists (ASA) Status I-IV Approval and sign of the informed consent Exclusion Criteria: Allergy to local anesthetics Puncture site infection Lack of signing of informed consent Age <18 years Emergency surgery ASA > IV preoperative acute respiratory failure

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