Thoracic Muscle Plane Block Research Articles

Analgesic Effectiveness of Truncal Plane Blocks in Patients Undergoing the Nuss Procedure: A Randomized Controlled Trial.

Most patients undergoing the Nuss procedure reported moderate to severe pain after surgery. This study aimed to investigate the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) combined with transversus thoracic muscle plane (TTMP) block for relieving acute pain in patients undergoing the Nuss procedure. The enrolled patients in our study were allocated to either receive combined nerve blocks with ropivacaine (NB group) or saline (CON group). The primary outcome of this study was postoperative pain at 2, 4, 8, 16, 24, 36, and 48h during rest and movement (coughing). Secondary outcomes included intraoperative dosage of remifentanil, the time to extubation and the length of stay in the post-anesthesia care unit (PACU), the total acetaminophen and codeine tablet consumption, time to first bowel movement, time to first flatus, opioid-related adverse events, and the length of hospital stay. Patients in the NB group had significantly lower Numerical Rating Scale (NRS) pain scores compared with the CON group. The NB group required significantly less postoperative acetaminophen consumption and lower dosages of perioperative sufentanyl and remifentanil compared with the CON group. The length of stay in the PACU and time to extubation were significantly increased in the CON group compared with the NE group. Time to first bowel movement and time to first flatus were earlier in the NB group. But there were no significant differences between the groups in terms of the length of hospital stay and codeine tablet consumption. Ultrasound-guided SAPB and TTMP blocks in patients undergoing the Nuss procedure could provide effective analgesia. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000038506).

Comparison of the effects of transversus thoracic muscle plane block and pecto-intercostal fascial block on postoperative opioid consumption in patients undergoing open cardiac surgery: a prospective randomized study

BackgroundThere is an association exists between cardiac surgery, performed through median sternotomy, and a considerable postoperative pain.ObjectivesThe aim of the current study is to compare the effects of transversus thoracic muscle plane block (TTMPB) and pecto-intercostal fascial plane block (PIFB) upon postoperative opioid consumption among the patients who underwent open cardiac surgery.MethodsThe present prospective, randomized, comparative study was conducted among 80 patients who underwent elective on-pump cardiac surgery with sternotomy. The subjects were randomly assigned to two groups with each group containing 40 individuals. For the TTMPB group, bilateral ultrasound-guided TTMPB was adopted in which 20 ml of 0.25% bupivacaine was used on each side. In case of PIFB group, bilateral ultrasound-guided PIFB was adopted with the application of 20 ml of 0.25% bupivacaine on each side. The researchers recorded the first time for rescue analgesia, the overall dosage of rescue analgesia administered in the first 24 h after the operation and the postoperative complications.ResultsThe PIFB group took significantly longer time to raise the first request for rescue analgesia (7.8 ± 1.7 h) than the TTMPB group (6.7 ± 1.4 h). Likewise, the PIFB group subjects had a remarkably lower ‘overall morphine usage’ in the first 24 h after the operation (4.8 ± 1.0 mg) than TTMPB group (7.8 ± 2.0 mg).ConclusionBilateral ultrasound-guided PIFB provided a longer time for the first analgesic demand than bilateral ultrasound-guided TTMPB in patients undergoing open cardiac surgery. In addition to this, the PIFB reported less postoperative morphine usage than the TTMPB and increases satisfaction in these patients.Trial registrationThis study was registered at Clinical Trials.gov on 28/11/2022 (registration number: NCT05627869).

Meta-Analysis of Open-Heart Surgery Pain Relief Using Transversus Thoracic Plane Blocks

Background. Severe postoperative pain is commonly reported following open-heart surgery, necessitating the implementation of effective pain management strategies to facilitate patient recovery. The benefits of the transverse thoracic muscle plane (TTMP) block for open-heart surgery remain unclear. Therefore, a meta-analysis was conducted to systematically evaluate the effect of TTMP on postoperative analgesia and recovery in patients undergoing open-heart surgery. Methods. A computer search was performed in PubMed, Cochrane, Embase, CNKI, and Wangfang databases. The primary outcome was 24-hour postoperative opioid consumption, and the secondary outcomes were 12- and 24-hour postoperative resting and motor pain scores, time of first analgesia demand, extubation time, length of stay in the intensive care unit (ICU), time of first feces, incidence of nausea and vomiting, and length of hospitalization. Results. Thirteen randomized controlled trials (RCTs) involving a total of 766 patients were included in this meta-analysis. Compared with the control group, the TTMP group showed a significant reduction in opioid consumption within 24 h postoperatively (mean difference = −41.88 mg; 95% confidence interval: −51.99, −31.77; p<0.001; and I2 = 98%). However, the 12- and 24-hour postoperative resting and moment VAS pain scores were significantly lower in the TTMP group. In addition, the TTMP group had a longer time of first analgesic demand; shorter endotracheal intubation time, ICU stay duration, time of first feces, and length of hospital stay; and a lower incidence of nausea and vomiting. Conclusions. Perioperative TTMP block can reduce the use of opioids in patients undergoing open-heart surgery for 24 h postoperatively, decrease the early postoperative pain scores, prolong the time of first analgesic demand, shorten the time of extubation and the length of ICU stay and hospitalization, and reduce the incidence of nausea and vomiting, which are all conducive to the recovery of patients. Registration. This trial is registered with PROSPERO database (CRD42022312435).

Continuous Bilateral Transversus Thoracicmuscle Plane Block: An Analgesia Boon for Scoliotic Patients Undergoing Cardiac Surgery.

A person with thoracolumbar scoliosis for cardiac surgery presents with problems of restrictive lung disease with the additional risk of reduced lung compliance and respiratory complications compared to the other patients. Post-operative analgesia in the form of continuous bilateral transversus thoracic muscle plane block (TTMPB) may help such patients in early respiratory rehabilitation by decreasing the time to extubation, reducing the opioid requirement, and early initiation of physiotherapy decreasing the risk of complications.

Ultrasound-Guided Modified Pectoral Nerve Block with Transversus Thoracic Muscle Plane Block: Review Article

Ultrasound-Guided Modified Pectoral Nerve Block with Transversus Thoracic Muscle Plane Block: Review Article

The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy

ABSTRACT Background Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy. Aim Of The Study The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation. Patients And Methods 50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision. Results There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation. Conclusion Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.

Transversus thoracic muscle plane block for pain during cardiac surgery: a systematic review and meta-analysis.

The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure. Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence. Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12h [weighted mean difference (WMD) -1.51cm on a 10cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference (RD) for achieving mild pain or less (≤3cm), 41%, 95% CI 17-65) and 24h (WMD -1.07cm, 95% CI -1.83 to -0.32; RD 26%, 95% CI 9-37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12h (WMD -3.42cm, 95% CI -4.47 to -2.37; RD 46%, 95% CI 12-80) and at 24h (WMD -1.73cm, 95% CI -3.24 to -0.21; RD 32%, 95% CI 5-59), intraoperative opioid use [WMD -28 milligram morphine equivalent (MME), 95% CI -42 to -15], postoperative opioid consumption (WMD -17 MME, 95% CI -29 to -5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95% CI 140-314), and intensive care unit (ICU) length of stay (WMD -13h, 95% CI -21 to -6). Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.

Comparison of regional anesthetic techniques for postoperative analgesia after adult cardiac surgery: bayesian network meta-analysis.

Patients usually suffer acute pain after cardiac surgery. Numerous regional anesthetic techniques have been used for those patients under general anesthesia. The most effective regional anesthetic technique was still unclear. Five databases were searched, including PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library. The efficiency outcomes were pain scores, cumulative morphine consumption, and the need for rescue analgesia in this Bayesian analysis. Postoperative nausea, vomiting and pruritus were safety outcomes. Functional outcomes included the time to tracheal extubation, ICU stay, hospital stay, and mortality. This meta-analysis included 65 randomized controlled trials involving 5,013 patients. Eight regional anesthetic techniques were involved, including thoracic epidural analgesia (TEA), erector spinae plane block, and transversus thoracic muscle plane block. Compared to controls (who have not received regional anesthetic techniques), TEA reduced the pain scores at 6, 12, 24 and 48 h both at rest and cough, decreased the rate of need for rescue analgesia (OR = 0.10, 95% CI: 0.016-0.55), shortened the time to tracheal extubation (MD = -181.55, 95% CI: -243.05 to -121.33) and the duration of hospital stay (MD = -0.73, 95% CI: -1.22 to -0.24). Erector spinae plane block reduced the pain score 6 h at rest and the risk of pruritus, shortened the duration of ICU stay compared to controls. Transversus thoracic muscle plane block reduced the pain scores 6 and 12 h at rest compared to controls. The cumulative morphine consumption of each technique was similar at 24, 48 h. Other outcomes were also similar among these regional anesthetic techniques. TEA seems the most effective regional postoperative anesthesia for patients after cardiac surgery by reducing the pain scores and decreasing the rate of need for rescue analgesia. https://www.crd.york.ac.uk/prospero/, ID: CRD42021276645.

Thoracic transversus plane block as part of a multimodal analgesia plan in a cat undergoing sternotomy

AbstractA 12‐year‐old, neutered, male, domestic shorthair cat presented for investigation of acute‐onset respiratory distress and cough. Computed tomography scan showed bilateral pleural effusion and dorsal elevation of the trachea compatible with a mass effect. A median sternotomy was performed. Anaesthetic protocol consisted of premedication with intravenous methadone (0.2 mg/kg), induction with alfaxalone to effect and maintenance with isoflurane in oxygen. Transversus thoracic muscle plane block was performed injecting 0.4 mL/kg of 0.25% bupivacaine per side. Fentanyl (2 μg/kg) was administered as rescue analgesia once during surgery. The Glasgow Composite Pain Scale was assessed postoperatively. Methadone was given as rescue analgesia postoperatively when Glasgow pain score was greater than 5/20. The first administration of methadone was required at 8 hours after the transversus thoracic muscle plane block was performed. This case showed that the ultrasound‐guided transversus thoracic muscle plane block is a feasible technique in feline patients as part of a multimodal analgesia plan in a cat undergoing sternotomy.

Transversus Thoracic Muscle Plane Block for Attenuating the Haemodynamic Response to Median Sternotomy: A Case Series.

With the emergence of opioid-sparing and enhanced recovery pathways, cardiac anaesthesiologists are highly motivated to formulate regional analgesia-centric multimodal regimes, particularly prompted by the inclusion of safer fascial plane blocks to the analgesic repertoire. Ahead of the encouraging literature on perioperative pain relief with the thoracic fascial plane blocks, the fraternity continues to search for promising options for ensuring sternal analgesia. While the novel transversus thoracic muscle plane block emerges as the recent kid on the block for effective sternal analgesia (in the most anatomical sense of the matter), the sporadic case reports and feasibility studies primarily focus on an overall perioperative analgesic role of the block. The index case series describes a noteworthy experience with a pre-induction transversus thoracic muscle plane block administration for attenuating the intraoperative (particularly, median sternotomy) haemodynamic response in adult cardiac surgical patients, with a potential to translate into reduced perioperative fentanyl requirement, augmented recovery, and fast-tracking.

Comparison of the Efficacy of Two Different Plane Blocks in Isolated Bypass Surgery: A Prospective Observational Study

This study evaluated the effects of serratus anterior plane block (SPB) and its combination with transverse thoracic muscle plane block (TTPB) on analgesia, opioid consumption, incentive spirometry performance, and patient comfort. A prospective, observational study. A university hospital. Adult patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Patients who received intravenous patient-controlled analgesia only were labeled as the control group. Patients who received additional SPB were labeled as the SPB group, and patients who received additional SPB and TTPB were labeled as the SPB+TTPB group. The visual analog scores for pain (VAS), time to first analgesic requirement, total tramadol requirement, incentive spirometry values, and patient comfort indices were recorded during the first 36 postoperative hours. From October 2020 to October 2021, data from 95 patients were analyzed. The VAS score was lower in the SPB+TTPB group at 0, 14, and 18 hours (p < 0.001, p=0.028, p=0.047, respectively). Time to first analgesic was longer in the SPB+TTPB group (8 hours v 0-2 hours, p=0.001). Total tramadol consumption was similar among groups. Incentive spirometer performance was superior in the SPB+TTPB group (p < 0.001). The SPB group had similar success at 0, 14, and 18 hours. Although pain scores and opioid consumption were similar, the addition of TTPB to SPB improved pain scores during patient mobilization and incentive spirometry capacity.

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic.

Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

Transverse thoracic muscle plane block as a routine strategy for cardiac enhanced recovery after surgery in sternotomy: A retrospective analysis.

The aim of this study is to retrospectively analyze and evaluate the effect of transverse thoracic muscle plane (TTP) block as a routine analgesic strategy for cardiac enhanced recovery after surgery in sternotomy.Patients received TTP block after general anesthesia and tracheal intubation were included in this study. The baseline clinical data of the patients, intraoperative use of sufentanil, internal mammary artery separating time, the postoperative duration of invasive ventilation, visual analogue scale, the compression times of patient-controlled intravenous analgesia in the first 3 days after surgery, and postoperative nausea and vomiting were recorded.A total of 104 cases was included and divided to G group (without TTP block) and TTP group (with TTP). Sufentanil use (sufentanil dose/min, sufentanil dose/kg body weight, sufentanil dose/[min kg]) in TTP group was significantly lower than that of G group. In G group, intraoperative use of sufentanil was correlated to the duration of anesthesia (P = .035). The postoperative visual analogue scale pain scores and the compression times of patient-controlled intravenous analgesia in the TTP group were significantly decreased compared with G group (P < .01). The postoperative duration of invasive ventilation of patients with normal and mildly impaired pulmonary function was significantly correlated to the use of sufentanil (P = .027, .009).TTP block has certain analgesic effect and can reduce sufentanil use in medium-length cardiac surgery and postoperative use of opioids. It is indicated that TTP block can be used as a routine enhanced recovery after surgery strategy for sternotomy in cardiac surgery.

The Analgesic Efficacy of Ultrasound-Guided Bilateral Transversus Thoracic Muscle Plane Block After Open-Heart Surgeries: A Randomized Controlled Study.

BackgroundWe aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral transversus thoracic muscle plane block after open-heart surgeries.MethodsSeventy patients aged above 18 years and scheduled for valve replacement or adult congenital via median sternotomy were enrolled in this study. Patients were divided into two groups, randomized by computer-generated random numbers: the block group, which had the ultrasound-guided bilateral transversus thoracic muscle plane block, and the control group, which had a sham block. The primary outcome was total fentanyl consumption in the first 24-hours. The secondary outcomes were pain score, time to the first analgesic request, time to extubation, ICU stays, and hospital stay.ResultsThe total fentanyl consumption in the first 24 hours was significantly lower in the block group, with a mean difference of −158.286 (95% CI = (−179.271 to −137.300; p =<0.0001)). The time to the first analgesic request was statistically significantly shorter in the non-block group (median 3 hours) than the block group (median 14 hours). During the postoperative period (0.5–24 hours), at-rest pain scores were 1.86 units lower in the block group (the estimate was −1.80, 95% CI = −2.14 to −1.45, t = −10.323 with p < 0.0001). Likewise, pain scores with cough were 3.29 units lower in the block group (the estimate was −3.29, 95% CI = −3.80 to −2.77, t = −12.703, p < 0.0001).ConclusionBilateral transversus thoracic muscle plane block is a promising and effective technique in reducing opioid consumption and controlling post-sternotomy pain after open-heart surgery via median sternotomy.

Editors’ Note: Ueshima H, Otake H. Addition of transversus thoracic muscle plane block to pectoral nerves block provides more effective perioperative pain relief than pectoral nerves block alone for breast cancer surgery. Br J Anaesth 2017;118:439–443

In response to concerns raised by John Loadsman, Editor-in-Chief of Anaesthesia and Intensive Care, Showa University conducted an inquiry into the integrity of manuscripts and letters to the editor by Hironobu Ueshima. Showa University released their report, in Japanese, on May 28, 2021. Showa University released an English translation on July 27, 2021. The investigation by Showa University referenced a list comprising all publications by Hironobu Ueshima.

Evaluation of the Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Post-Sternotomy Pain: A Randomized Controlled Trial.

PurposeTransverse thoracic block is a new perioperative analgesic method for post-sternotomy discomfort. This study discusses the efficacy of an ultrasound-guided transversus thoracic muscle plane block (TTPB) in patients undergoing heart surgery, including sternotomy.Patients and MethodsIn this prospective trial, 60 patients were randomly assigned to two groups: transversus (T) or general anesthesia (GA). Patients in the T group received TTPB with GA and 15 mL of 0.25% bupivacaine was administered on either side. Patients in the GA group received TTPB along with GA, but 15 mL saline was injected on either side instead. The patients were followed up postoperatively. The percentage of patients receiving additional opioids, extubation time, intensive care unit (ICU) length, postoperative morphine dose, and adverse events were documented.ResultsThe percentage of patients requiring additional morphine was significantly lower in the T group (p<0.015). Pain scores were comparable between the groups at extubation time and 18 h postoperatively. At 8, 12, and 24 h after surgery, pain scores in the T group were significantly lower (P<0.001). The total amount of morphine required after surgery was much lower in the T group (8±0.74 mg), and the duration to initial analgesic necessity was significantly greater in the GA group (P<0.001). Patients in the GA group had a considerably longer ventilation time (11.07±0.64) (P<0.001). The ICU stay in the T group was substantially shorter (P<0.001), and postoperative complications were comparable.ConclusionFor patients undergoing heart surgery, TTPB offers sufficient postoperative pain control, resulting in lower pain scores, lower postoperative analgesic doses, shorter extubation times, and shorter ICU stay lengths.

Comparison of Ultrasound-Guided Pecto-intercostal Fascial Block and Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind Pilot Study

The objective of the present study was to evaluate morphine consumption and pain scores 24 hours postoperatively to compare the effects of a bilateral pectointercostal fascial block (PIFB) with those of a transversus thoracic muscle plane block (TTMPB) on acute poststernotomy pain in cardiac surgery patients who have undergone median sternotomy. Prospective, randomized, double-blinded. The operating room, intensive care unit, and patient ward at a university hospital. Thirty-nine American Society of Anesthesiologists II-to-III patients aged 18- to-80 years, scheduled for elective cardiac surgery via median sternotomy. Patients randomly were allocated to groups scheduled to receive bilateral ultrasound-guided PIFB or TTMPB. The primary outcome was postoperative morphine use within the first 24 hours. Secondary outcomes were the numerical pain rating scale (NRS) scores at rest and during coughing, time of first analgesic demand from the patient-controlled analgesia (PCA) device, and rescue analgesia use. The nausea/vomiting scores, time to extubation, length ofstays in intensive care and the hospital, patient satisfaction scores, and complications were also recorded. The first 24-hour morphine use did not significantly differ between the PIFB and TTMPB groups (mean ± standard deviation [95% CI], 13.89 ± 6.80 [10.83-16.95] mg/24 h and 15.08 ± 7.42 [11.83-18.33] mg/24 h, respectively, p=0.608). No significant difference between the two groups in the NRS scores at rest and during coughing was observed; the groups had similar requirements for rescue analgesia in the first 24 hours (n [%], three [15.8] and seven [35], p=0.273, respectively). The time from PCA to the first analgesia request was longer in the PIFB than in the TTMPB group (median [interquartile range], 660 [540-900] minutes, and 240 [161-525] minutes, respectively, p=0.002). PIFB and TTMPB showed similar effectiveness for morphine consumption within 24 hours postoperatively and in pain scores in cardiac surgery patients.

Analgesic Efficacy of Regional Anesthesia of the Hemithorax in Patients Undergoing Subcutaneous Implantable Cardioverter-Defibrillator Placement

Patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement usually experience substantial perioperative pain. The aim of the present study was to investigate the effect of transversus thoracic muscle plane block combined with serratus anterior plane block in patients undergoing S-ICD placement. Double-blind, randomized controlled study. First Affiliated Hospital of Nanchang University. Patients aged 18-to-80 years who underwent new S-ICD placement. A group of 80 patients randomly were allocated to either the regional group (R group) or local group (L group). The primary endpoint was pain during S-ICD placement. The secondary outcome measures included pain intensity at rest and after movement one, three, six, 12, 24, and 48 hours after surgery; the dose of dexmedetomidine and remifentanil during surgery; 24-hour ketorolac administration; postoperative sufentanil dosage; the total duration of hospitalization; intraoperative sedation; and the incidence of hypoxemia. Mean Critical-Care Pain Observation Tool scores were significantly higher during pocket creation, lead tunneling A, and lead tunneling B in the L group compared with the R group. The R group required significantly less intraoperative dexmedetomidine, intraoperative remifentanil, postoperative sufentanil, and ketorolac consumption. Compared with the R group, the L group had higher Numerical Rating Scale pain scores at 24 hours after surgery both at rest and after movement. The intraoperative Ramsay score and the incidence of hypoxemia were significantly higher in the L group compared with the R group. Ultrasound-guided transversus thoracic muscle plane block and serratus anterior plane block resulted in lower intraoperative Critical-Care Pain Observation Tool scores and the need for less adjunctive pain medication and sedation compared with local anesthesia in patients undergoing S-ICD placement.

Efficacy of Truncal Plane Blocks in Pediatric Patients Undergoing Subcutaneous Implantable Cardioverter–Defibrillator Placement

Pediatric patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement usually have substantial postoperative pain. The aim of this study was to investigate the effect of the transversus thoracic muscle plane (TTMP) block combined with serratus anterior plane block (SAPB) in patients undergoing S-ICD placement. A double-blind, randomized controlled study. First Affiliated Hospital of Nanchang University. Patients aged nine-to-18 years undergoing S-ICD placement were included. A group of 102 patients randomly were allocated to either receive combined nerve blocks (NER group) or no nerve block (CON group). The primary endpoint was perioperative fentanyl consumption. The secondary outcome measures included pain at rest and after movement at two, four, six, 12, 24, and 48 hours after extubation; 48-hour acetaminophen administration; time to extubation; length of stay in the postanesthesia care unit (PACU); length of hospital stay; codeine tablet consumption; and percentage of patients who had codeine tablets after discharge. The NER group reported significantly less intraoperative (4.1 μg/kg v 3.1 μg/kg, p = 0.04) and postoperative fentanyl consumption (3.8 μg/kg v 1.5 μg/kg, p = 0.006) than the CON group. Compared with the NER group, the CON group had higher Numerical Rating Scale (NRS) pain scores at 24 hours after surgery both at rest and after movement. The time to extubation (20.5 minutes v 12.6 minutes, p = 0.03) and length of stay in the PACU (30.5 minutes v 15.6 minutes, p = 0.02) were significantly decreased in the NER group compared with the CON group. The CON group had a significantly higher postoperative acetaminophen requirement than did the NER group (32 mg/kg v 16 mg/kg, p = 0.01). TTMP block combined with SAPB in pediatric S-ICD placement could provide effective analgesia.

Transversus Thoracic Muscle Plane Block for Analgesia After Pediatric Cardiac Surgery

The objective of this study was to assess the effectiveness of transversus thoracic muscle plane block (TTPB) as a novel technique for postoperative analgesia in pediatric cardiac surgery. A retrospective study. A tertiary care teaching hospital. Children who underwent congenital heart surgery through median sternotomy between January 2018 and March 2019. Bilateral ultrasound-guided TTPB was performed as a single-shot technique before the sternal incision. A total dose of bupivacaine 0.25% (0.5 ml/kg) was injected between the fourth and fifth ribs just lateral to the sternum. Patients who received TTPB were designated as the TTPB group, and the other group was named the non-TTPB group MEASUREMENTS AND MAIN RESULTS: Thirty-three patients underwent intraoperative bilateral TTPB before the sternal incision and 37 did not. The groups were comparable as for demographic and intraoperative clinical characteristics. Pain scores were significantly lower in the TTPB group compared with the non-TTPB group (p < 0.001). Intraoperatively, non-TTPB patients received significantly higher doses of fentanyl (p < 0.001). Moreover, the total fentanyl dose during a 24-hour period was also higher in the non-TTPB group (p < 0.001). The time to extubation was significantly lower in the TTPB group than in the non-TTPB group (p < 0.001). TTPB appeared to be an effective technique for postoperative analgesia in pediatric patients undergoing cardiac surgery using a median sternotomy approach.