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

• Published in: Egyptian journal of anaesthesia Vol. 39; no. 1; pp. 488 - 495
• Main Authors: Nessim, Fady Medhat Mokhtar, Hassan, Alaa Eid Mohamed, Eskander, Fahmy Saad Latif, Nady, Riham Fathy Galal
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 31.12.2023; Taylor & Francis Group
• Subjects: open heart surgeries; rectus sheath block; sternotomy; Transverse thoracic muscle; TTP block
• ISSN: 1110-1849; 1687-1804; 1110-1849
• DOI: 10.1080/11101849.2023.2227474

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. 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. 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. 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. 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.