Author(s): Hemang Gandhi1, Rajesh Thosani2, Harshil Joshi3, Himanshu Acharya4, Chirag Doshi5, Nirav Parikh6
Optimum pain relief following mini invasive CABG is essential for patient comfort and to reduce the incidence of postoperative pulmonary complications. METHODS: A randomized clinical trial was conducted on 30 patients scheduled for mini CABG. The patients were randomly divided into two groups. After surgery in group A- paravertebral infusion of local anaesthetics (PVB), bolus dose of 5 ml of 0.25% bupivacaine was injected through the paravertebral catheter in supine position; followed by an infusion of 0.125% bupivacaine at the rate of 0.1 ml/kg/hr, which was continued in the postoperative period. In group B- intravenous paracetamol (IVP), after shifting patient to ICU paracetamol infusion of 10mg/ml is started a 15 ml/hr if patient weight is >50kg. If patient weight is <50 kg infusion started at 0.3ml/kg/hr. Adequacy of analgesia was assessed at rest and during coughing over 48 hours. Analgesic efficacy was assessed using a visual analogue score. RESULTS: Pain scores were significantly higher in Group A during the assessment period. (p<0.01) as compared to the group B. Forced expiratory volume in one second (FEV1), arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) showed better results in group A as compared with group B. ventilation time and ICU stay were also less in patients who received paravertebral analgesia. CONCLUSION: We conclude that in the early postoperative period, the use of 0.125% bupivacaine infusion through the paravertebral catheter in patients undergoing mini CABG improves pain relief and decrease pulmonary complication.