Comparison of the Local Anaesthetics Articaine and Bupivacaine in Treatment of Acute Sternum Pain After Heart Surgery
Comparison of the Local Anaesthetics Articaine and Bupivacaine in Treatment of Acute Sternum Pain After Heart Surgery
The purpose of this study is to examine the wound infusion of articaine for treatment of
 acute post-sternotomy pain in a placebo-controlled manner using a prospective and randomized
 design and an active control (bupivacaine)
Acute pain after open heart surgery can be moderate or strong and is mostly caused by
 sternotomy. Pain is the worst during the first two post-operative days and, if not adequately
 treated, can delay the patient´s recovery from surgery. Sternotomy pain can be alleviated by
 using paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. All these
 drugs may have remarkable side-effects which may delay the recovery from surgery: opioids are
 respiratory depressants and slower the gastrointestinal motility, NSAIDs reduce intrarenal
 blood flow and may disturb coagulation. Post-operative opioid consumption can be reduced by
 using wound infiltration analgesia.

 The use of wound infiltration analgesia has not been extensively investigated in treatment of
 acute pain after sternotomy. There is some evidence, that 0.5% bupivacaine reduces the acute
 post-sternotomy pain when infused constantly via catheters placed under the fascia
 (periosteal placement) and the skin.

 During 48 hours infusion toxic bupivacaine plasma levels were not observed. There is an
 evidence that local anesthetics can be bacteriostatic both in vitro and in vivo.

 Articaine is an amide-type local anesthetics, which has been used extensively in dental
 procedures since more than forty years. It has been successfully used in infiltration,
 epidural, spinal and other regional anesthesia procedures. Articaine is quickly hydrolyzed in
 plasma and excreted by kidneys. Clearance of articain (500-1110l/h) is faster than that of
 lidocaine (68l/h) and it is also the reason for articaine´s low toxicity profile. Because of
 it´s low toxicity and high ability to penetrate the periosteal tissue, articaine may be
 advantageous in treatment of acute pain after sternotomy, but aforementioned indication for
 use of articaine has not been investigated. Compared to other local anesthetics, articaine in
 high concentration has the same neurotoxicity profile, when injected directly into rat´s
 sciatic nerve. Articaine has not been extensively compared to other local anesthetics, but
 according the latest odontologic investigation, single dose 0.5% bupivacaine and single-dose
 4% articaine were comparable in their analgesic effects during tooth extraction procedure.
 There are no controlled randomized trials comparing analgesic effect of articaine and other
 local anesthetics infusions.

 In our investigation bupivacain 0.5 % was chosen as an active control, because it has
 appeared effective in acute postoperative pain and it has reduced the need for opioid
 analgetics after sternotomy
Inclusion Criteria:

 -  elective procedure

 -  open heart surgery

 -  aortic valve surgery

 -  mitral valve surgery

 -  atrial septal defect repair surgery

 -  intracardial myxoma removal surgery

 Exclusion Criteria:

 -  local anesthetic allergy

 -  sulphide allergy

 -  asthma

 -  pregnant women

 -  neurological disease (TIA excluded)

 -  congestive heart failure

 -  left ventricle ejection fracture under 0.3

 -  liver failure

 -  diabetes mellitus with documented polyneuropathy

 -  chronic pain condition

 -  mother tongue not finnish or swedish

 -  patients, who do not agree blood transfusions