This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.

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Background:During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.Patients and Methods:A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.Results:Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.Conclusion:The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.

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BackgroundAngina symptom in patients with ischemic cardiomyopathy (ICM) after coronary artery bypass grafting (CABG) surgery is a major challenging problem in practice. The choice among different treatment modalities available can be judged by different parameters especially measuring the risk/cost ratio to achieve the benefit. Enhanced external counter pulsation (EECP) is one of safest noninvasive modality for treatment of angina as well as it has an anti-failure effect.Patients and method42 patients with ICM after CABG were suffering from stable angina and were treated at Al-Hayat Cardiology Centre in Tanta City (ACC). 20 patients of them (group A) received 35 sessions of EECP plus their anti-ischemic and anti-failure treatment, while the other 22 patients (group B) received only medical treatment and were followed up for 3 months regarding their angina class, functional class, frequency of angina attack, frequency of sublingual nitrate and rate of rehospitalization when needed during follow up period.ResultsDespite both groups had nearly similar severity of symptoms regarding the CCS class and NYHA class, yet patients in group A experienced significant improvement in comparison to patients in group B (p-value = .005, p-value = .002 respectively), and this was reflected on frequency of angina and need for sublingual nitrates per week which showed significant decrease in group A (p-value = .001).ConclusionAs a non-invasive treatment modality EECP is very effective in improving the symptoms of angina and heart failure when combined with medical treatment in patients with ICM after CABG.