Status
Conditions
Treatments
About
Optimal multimodal opioid-sparing analgesic technique is considered as one of the most important Enhanced recovery pathways (ERPs) or enhanced recovery after surgery (ERAS) interventions that mitigate the undesirable effects of surgical stress response. Implementation of ERP has been shown to reduce postoperative complications and shorten the hospital LOS.
Full description
In this study, the investigator hypothesizes that by using continuous infusion of ketamine or dexmedetomidine in addition to NSAIDs, the investigator can reduce or completely eliminate opioid use in adult patients after cardiac surgery.
The anesthesia technique was composed of the following 10 steps:
(6) Perioperative Glycemic Control: Insulin infusion, and the perioperative Goal glucose ≤ 150 - 180.
(7)Perioperative hemoglobin concentration: Goal hemoglobin transfusion trigger: 7.5 regardless of patient Age and Comorbidity. (8) Protamine: Post CPB protamine (heparin reversal) given up to the full dose (5 mg/kg after test dose) to return to baseline ACT.
(9) Multimodal analgesia: In addition to continuous infusion of Fentanyl, at the end of the surgery, Paracetamol: 1 gm IV infusion over 15 min was administered with the sternum closure, and Surgical Incision Field Block using 30 ml of Bupivacaine 0.5% just before dressing. The patient will then be transferred intubated to Surgical ICU (SICU). (10) In SICU: Postoperative analgesia will be carried out for all groups. All patients will receive IV fentanyl via patient-controlled analgesia (PCA) with (10 µg.mL-1, with a bolus of 15 µg, and lockout 10 minutes, maximum cumulative dose of 90µ.hr-1 and no background dose). Before extubation, analgesia will be given as nurse-controlled analgesia (NCA) with the same regimen, depending on the sudden rise in HR or MABP ≥20% of the baseline. The total of 24 h. opioid consumption will be recorded.
At this step, and for opioid-sparing analgesia and sedation, using the sealed envelope technique, patients will be randomly divided into three groups: Group (K): (n=30) will receive ketamine infusion of 1-2 μg/kg/min (0.12 mg/kg/h) titrated to the desired level of sedation. Group (D): (n=30) will receive Dexmedetomidine infusion 0.1- 0.2 μg/kg/hour titrated to desired level of sedation. Group (C): (n=30) will receive fentanyl only. All hemodynamic monitors used intraoperatively are continued in SICU, and in addition, the following parameters are used to monitor the level of analgesia and sedation -During mechanical ventilation: Richmond Agitation-Sedation Scale
Enrollment
Sex
Ages
Volunteers
Inclusion criteria
Exclusion criteria
Primary purpose
Allocation
Interventional model
Masking
90 participants in 3 patient groups, including a placebo group
Loading...
Data sourced from clinicaltrials.gov
Clinical trials
Research sites
Resources
Legal