Chronic pain is a common complication after cardiothoracic surgery. The prevalence of post-sternoyomy pain syndrome (PSPS) ranges from 33% to 91%. Exact pathogenetic mechanisms for developing chronic pain after sternotomy are unknown. Apart from intraoperative nerve damage and subsequent postoperative neuropathic pain, operation techniques, age, sex, pre-existing pain, genetic and psychosocial factors, severe postoperative pain, and analgesic management are suspected to have an impact on the development of PSPS .
age between 18 and 75 years.
patient scheduled to undergo elective on-pump cardiac surgery with sternotomy.
American Society of Anesthesiologists classification of physical status < IV.
emergency surgery.
off-pump surgery.
redo surgery.
ejection fraction less than 35%.
Parallel
pecto intercostal fascial block using bupivacaine 0.25%
Procedure/Surgerypatients will receive bilateral ultrasound-guided pecto-intercostal fascial block using 20 ml of bupivacaine 0.25% for each side.
lidocaine infusion
Drug1.5 mg/kg lidocaine will be administered after induction of anesthesia, then 2mg/kg/h lidocaine will be administered with continuous intravenous infusion until the end of the surgery.
Total dose of morphine in the first 24 h postoperatively.
total morphine consumed in the first 24 hour
NRS numerical rating scale.
NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief
chronic postoperative pain in 3 months after operation according to numerical rating scale
NRS ranging from grade 0 (no pain) to grade 10 (most severe pain) NRS\< 4 is acceptable for pain relief
Time to rescue analgesic
time from extubation to the time the patiants given analgesia
time to extubation
from end of surgery to the time of extubation
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