Title: Early Extubation is Enhanced in Patients Receiving Local Infiltration over the Opioid Based Anaesthesia in Cardiac Surgery Patients
Authors: Hakeem Zubair Ashraf, Mohd Yaqoob Khan, Nadeem-ul-Nazeer Kawoosa, Haroon Naqshi, Abdul Majeed Dar, Mohammad Akbar Bhat, Talib Khan
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.117
Abstract
Objective: To study the comparative effect of local anaesthetic infiltration and systemic opioid analgesia on the early extubation in cardiac surgeries.
Introduction: Sternotomy inflicts severe surgical trauma and affects the pulmonary functions and the subsequent recovery. Various modalities have been employed to alleviate the implications of pain. Local infiltration of anaesthetics has been documented with good results.
Material and Methods: Eighty (80) patients in the age group of 18 to 50 years planned for open heart surgeries were divided into two groups A and B of forty (40) patients each. Group A patients received infusion of fentanyl @1mcg/kg/hr while as in group B 20ml of 0.5% Ropivacaine was given subcutaneously at sternotomy site. In addition, in group A, 50 mcg bolus of fentanyl was given at the time of sternotomy while as group B patients received 10 ml bolus of 0.2% Ropivacaine.
After completion of surgery patients were shifted to Cardiac ICCU and were observed for early awakening and extubation.
Results: 85% of group B patients were extubated within 2 hours after surgery. The mean time duration of post operative ventilation in group B patients was 1.7 hours. In contrast 32.5% of patients of the Group A could be extubated within 2 hours. The mean duration of postoperative ventillation in group B was 5.2 hours.
Furthermore the group B patients had a better post operative pain control and breathing pattern than the group A patients.
None of the patients of the either group was re-intubated.
Conclusion: Infiltration of surgical wounds with local anaesthetics improves pain scores and reduces opioid consumption and facilitates early extubation and improvement of post extubation breathing and blood gas parameters.
Keywords: Cardiac Surgery, Local infiltration, systemic opioid anaesthesia, effects, recovery.
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