الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Advances in cardiac surgery, anesthesia and postoperative care have had a significant impact on survival and quality of life for patients after these procedures.
Hypertension and tachycardia are common side effects of pain, which can exacerbate myocardial ischemia. Furthermore, chonic pain syndromes might develop as a result of poor postoperative pain control.
Compared to central neuoro-axial blocks, paravertebral nerve blocks (PVBs) can provide superior perioperative analgesia conditions with fewer side effects and contraindications.
High doses or extended administration of conventional opioids, on the other hand, might lead to their accumulation, resulting in postoperative respiratory depression and a longer stay in the intensive care unit.
This prospective randomised study was conducted at Beni-Suef University Hospitals cardiac surgery unit on patients undergoing heart surgery via median sternotomy to compare the effects of IV fentanyl and TPVB on haemodynamic responses and critical care pain observational tool in these patients, induction of anaesthesia in 44 patients of both sexes, aged 18-65 years old. Patients were divided into two equal groups at random (each with 22 patients).
group I (control group) (n=22) receiving conventional GA and a fentanyl infusion of 2 mcg/kg/h following tracheal intubation, which was ceased at the end of the procedure.
group II (TPVB) (n=22): Bilateral thoracic paraverteberal catheters were inserted preoperative at level of T4 in order to block thoracic dermatomal levels from T3-T7 and 0.3ml/kg 0.25% bupivacaine bouls dose in each catheter maximum 20 ml in each side before induction and testing sensation bilaterally by pinprick and ice after 15-20min from injection then standard GA and after tracheal intubation continuous infusion of 0.1 ml /kg/h 0.25% bupivacaine in each catheter and stopped at the end of the operation. Recordings of heart rate and mean arterial blood pressure recorded before induction , 1 min before skin incision ,3 min after skin incision , 1 min before sternotomy ,3 min after sternotomy .
Critical care pain observational tool was recorded at 8h,12h,24h post operative since admission in ICU also total intraoperative fentanyl used, total post operative morphin used, Time of extubation since discharge from operating theater ,duration of ICU stay and amount of chest tube drainage
This study showed that bilateral continuous thoracic paravertebral block was more effective than IV Fentanyl infusion for perioperative analgesia in patients Underwent cardiac surgery through median sternotomy.