Improved XXXX control after cardiac surgery: results of a randomized, double-blind, clinical trial.

@entity1 @entity1337 @entity1342 @entity158 @entity282
OBJECTIVE: We sought to determine whether a continuous regional infusion of a local anesthetic delivered to the operative site would result in decreased levels of @entity282 and narcotic requirements for @entity1 who undergo a standard median sternotomy for cardiac surgery. METHODS: A double-blind, randomized, controlled trial was conducted at a single center. @entity1 who were undergoing elective coronary artery bypass graft surgery alone or combined with laser transmyocardial revascularization received bilateral intercostal nerve blocks with either @entity1342 or saline. At wound closure, 2 catheters with multiple side openings were inserted percutaneously and placed directly over the sternum. The same agent ( @entity1342 vs saline) was then administered as a continuous regional infusion for 48 hours through an elastomeric pump. Requirements for postoperative systemic narcotic analgesics and @entity158 assessment scores were recorded for 72 hours after the operation. Secondary outcome measures were hospital length of stay and pulmonary function test results. @entity158 scores and narcotic use on the second postoperative day were also compared to avoid the confounding influence of anesthesia administered at the time of the operation. RESULTS: The total amount of @entity1337 required by the @entity1342 group was significantly less than that of the control group (47.3 vs 78.7 mg, respectively; P =.038). The @entity1342 group required less narcotics on postoperative day 2 as well (15.5 vs 29.4 mg, P =.025). The mean overall @entity158 scores for the @entity1342 group were significantly less than the mean overall scores for the normal saline group (1.6 vs 2.6, respectively; P =.005). @entity1 receiving @entity1342 had a mean length of stay of 5.2 days compared with 8.2 days for @entity1 in the normal saline group (P =.001). Excluding the data from outliers (length of stay = 39 days), the normal saline group mean length of stay was 6.3 days (P <.01). There was no difference in assessment of pulmonary function. CONCLUSION: Continuous delivery of local anesthetics significantly improved @entity282 control while decreasing the amount of @entity1337 required in @entity1 who underwent standard median sternotomy. There was also a significant decrease in hospital length of stay, which is likely to result in significant cost reductions.
