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Cui YY, Xu ZQ, Hou HJ, Zhang J, Xue JJ. Transversus Thoracic Muscle Plane Block For Postoperative Pain in Pediatric Cardiac Surgery: A Systematic Review And Meta-Analysis of Randomized And Observational Studies. J Cardiothorac Vasc Anesth 2024; 38:1228-1238. [PMID: 38453555 DOI: 10.1053/j.jvca.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Pediatric patients undergoing cardiac surgery usually experience significant surgical pain. Additionally, the effect of poor surgical analgesia creates a pain continuum that extends to the postoperative period. Transversus thoracic muscle plane block (TTMPB) is a novel plane block technique that can provide analgesia to the anterior chest wall. The analgesic role of TTMPB in pediatric cardiac surgery is still uncertain. A meta-analysis was conducted to determine the analgesic efficacy of this procedure. DESIGN AND SETTING Systematic review and meta-analysis. PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure were searched to November 2023, and the Grading of Recommendations Assessment, Development, and Evaluation approach was followed to evaluate the certainty of evidence. PARTICIPANTS Eligible studies enrolled pediatric patients from 2 months to 12 years old scheduled to undergo cardiac surgery, and randomized them to receive a TTMPB or no block/sham block. MEASUREMENTS AND MAIN RESULTS Six studies that enrolled 601 pediatric patients were included. Low-certainty evidence from randomized trials showed that, compared with no block or sham block, TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative modified objective pain score at 12 hours (weighted mean difference [WMD] -2.20, 95% CI -2.73 to -1.68) and 24 hours (WMD -1.76, 95% CI -2.09 to -1.42), intraoperative opioid consumption (WMD -3.83, 95% CI -5.90 to -1.76 μg/kg), postoperative opioid consumption (WMD -2.51, 95% CI -2.84 to -2.18 μg/kg), length of intensive care unit (ICU) stay (WMD -5.56, 95% CI -8.30 to -2.83 hours), and extubation time (WMD -2.13, 95% CI -4.21 to -0.05 hours). Retrospective studies provided very low certainty that the results were consistent with the randomized trials. CONCLUSION Very low- to low-certainty evidence showed that TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative pain, opioid consumption, ICU length of stay, and extubation time.
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Affiliation(s)
- Yi-Yang Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District, Lanzhou, China
| | - Zi-Qing Xu
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Huai-Jing Hou
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Jie Zhang
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Jian-Jun Xue
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu, Lanzhou, China.
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Harbell MW, Langley NR, Seamans DP, Kraus MB, Carey FJ, Craner RC. Deep parasternal intercostal plane nerve block: an anatomical study. Reg Anesth Pain Med 2024; 49:179-183. [PMID: 37419507 DOI: 10.1136/rapm-2023-104716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION The superficial and deep parasternal intercostal plane (DPIP) blocks are two new blocks for thoracic pain. There are limited cadaveric studies evaluating the dye spread with these blocks. In this study, we examined the dye spread of an ultrasound-guided DPIP block in a human cadaveric model. METHODS Five ultrasound-guided DPIP blocks were performed in four unembalmed human cadavers using an in-plane approach with a linear transducer oriented in a transverse plane adjacent to the sternum. Twenty milliliters of 0.1% methylene blue were injected between ribs 3 and 4 into the plane deep to the internal intercostal muscles and superficial to the transversus thoracis muscle layer. The chest muscles were dissected, and the extent of dye spread was documented in both cephalocaudal and mediolateral directions. RESULTS The transversus thoracis muscle slips were stained in all cadavers from 4 to 6 levels. Intercostal nerves were dyed in all specimens. Four levels of intercostal nerves were dyed in each specimen with variability in number of levels stained above and below the level of the injection. CONCLUSIONS The DPIP block spreads along the tissue plane above the transversus thoracis muscles to multiple levels to dye the intercostal nerves in this cadaver study. This block may be of clinical value for analgesia in anterior thoracic surgical procedures.
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Affiliation(s)
- Monica W Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Natalie R Langley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - David P Seamans
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Molly B Kraus
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Frederick J Carey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Ryan C Craner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
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Skojec AJ, Christensen JM, Yalamuri SM, Smith MM, Arghami A, LeMahieu AM, Schroeder DR, Mauermann WJ, Nuttall GA, Ritter MJ. Deep Parasternal Intercostal Plane Block for Postoperative Analgesia After Sternotomy for Cardiac Surgery-A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:189-196. [PMID: 37968198 DOI: 10.1053/j.jvca.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 09/29/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To examine the analgesic efficacy of postoperative deep parasternal intercostal plane (DPIP) blocks for patients having cardiac surgery via median sternotomy. DESIGN This single-center retrospective study compared patients receiving bilateral DPIP blocks with a matched cohort of patients not receiving DPIP blocks. SETTING Large quaternary referral center. PARTICIPANTS Adult patients admitted to the authors' institution from January 1, 2016, to August 14, 2020, for elective cardiac surgery via median sternotomy. INTERVENTIONS Patients received ultrasound-guided bilateral DPIP blocks. MEASUREMENTS AND MAIN RESULTS A total of 113 patients received a DPIP block; 3,461 patients did not. The estimated multiplicative change in cumulative opioid consumption through 24 hours was 0.42 (95% CI 0.32-0.56; p < 0.001), indicating that patients receiving DPIP blocks required 60% fewer opioids than patients who did not. Proportional odds ratios for the average pain score on postoperative day (POD) 0 was 0.46 (95% CI 0.32-0.65; p < 0.001), and POD 1 was 0.67 (95% CI 0.47-0.94; p = 0.021), indicating lower pain scores for patients receiving blocks. The exploratory analysis identified an inverse correlation between DPIP blocks and atrial fibrillation incidence (2% v 15%; inverse probability of treatment weighting odds ratio 0.088, 95% CI 0.02-0.41; p = 0.002). CONCLUSIONS The use of DPIP blocks in patients undergoing cardiac surgery via median sternotomy was associated with less opioid use and improved pain scores in the early postoperative period compared with patients not receiving blocks. Prospective randomized controlled studies should further elucidate the efficacy and risks of DPIP blocks in cardiac surgery.
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Affiliation(s)
- Alexander J Skojec
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jon M Christensen
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Suraj M Yalamuri
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Allison M LeMahieu
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Gregory A Nuttall
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Matthew J Ritter
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesia, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Chen C, Xiang G, Liu Q, Chen K, Wang H, Jin J, Huang Y, Deng X, Yang D, Yan F. Ultrasound-guided Serratus Anterior Plane Block, Along with Improved Parasternal Block, is Superior to Serratus Anterior Plane Block Alone in Relieving Pain for Rhinoplasty with Autologous Costal Cartilage. Aesthetic Plast Surg 2023; 47:1975-1984. [PMID: 36544049 DOI: 10.1007/s00266-022-03230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest. METHODS Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. RESULTS: Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower (P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished (P < 0.05), and the patient satisfaction was markedly higher (P < 0.001) in the SAPB+PSB group. CONCLUSION USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Chunmei Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Guihua Xiang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Quanle Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Keyu Chen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Huan Wang
- Department of Rhinoplasty and Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Jing Jin
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Yan Huang
- Department of Nursing, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Xiaoming Deng
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.33, Ba Da Chu Road, Shi Jing Shan District, Beijing, 100144, China.
| | - Fuxia Yan
- Department of Anesthesiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, North Li shi Road, Xi Cheng District, Beijing, 100037, China.
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Xue JJ, Cui YY, Busse JW, Ge L, Zhou T, Huang WH, Ding SS, Zhang J, Yang KH. Transversus thoracic muscle plane block for pain during cardiac surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:2500-2508. [PMID: 37246971 PMCID: PMC10442103 DOI: 10.1097/js9.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
STUDY OBJECTIVE 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. DESIGN 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. STUDY ELIGIBILITY CRITERIA Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. MAIN RESULTS 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 12 h [weighted mean difference (WMD) -1.51 cm on a 10 cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference (RD) for achieving mild pain or less (≤3 cm), 41%, 95% CI 17-65) and 24 h (WMD -1.07 cm, 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 12 h (WMD -3.42 cm, 95% CI -4.47 to -2.37; RD 46%, 95% CI 12-80) and at 24 h (WMD -1.73 cm, 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 -13 h, 95% CI -21 to -6). CONCLUSION 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.
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Affiliation(s)
- Jian-jun Xue
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine
- Gansu Clinical Research Center of Integrative Anesthesiology
| | - Yi-yang Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jason W. Busse
- Department of Anesthesia
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Long Ge
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Ting Zhou
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Wei-hua Huang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Sheng-shuang Ding
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jie Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Ke-hu Yang
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
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Ling Q, Zhao S, Shi Y, Li X, Li P, Zhao G, Zhu Q. Transversus Thoracis Muscle Plane Block in Paediatric Patients Who Underwent Minimally Invasive Closure of Transthoracic Ventricular Septal Defect: A Retrospective Study. Pain Res Manag 2023; 2023:3488552. [PMID: 36999119 PMCID: PMC10049843 DOI: 10.1155/2023/3488552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
Objective Minimally invasive closure of transthoracic ventricular septal defect (VSD) has been widely used in paediatric patients. This retrospective study aimed to explore the use of transversus thoracis muscle plane block (TTMPB) in the minimally invasive closure of transthoracic VSD in paediatric patients. Methods From September 28, 2017, to July 25, 2022, a total of 119 paediatric patients scheduled for minimally invasive transthoracic VSD closure were considered for inclusion. Results In total, 110 patients were included in the final analysis. Perioperative fentanyl consumption of the TTMPB group was not different from that of the non-TTMPB group (5.90 ± 1.32 μg/kg vs. 6.25 ± 1.74 μg/kg, p = 0.473). Both the time to extubation and postanesthesia care unit (PACU) stay were significantly shorter in the TTMPB group than in the non-TTMPB group (10.94 ± 10.31 min vs. 35.03 ± 23.52 min for extubation, and 42.55 ± 16.83 min vs. 59.98 ± 27.94 min for PACU stay, both p < 0.001). Furthermore, the postoperative paediatric intensive care unit (PICU) stay in the TTMPB group was significantly shorter than in the non-TTMPB group (1.04 ± 0.28 d vs. 1.34 ± 1.05 d, p = 0.005). Multivariate analysis demonstrated that TTMPB was significantly associated with shorter time to extubation (p < 0.001) and PACU stay (p = 0.001) but not postoperative PICU stay (p = 0.094). Discussion. This study showed that TTMPB was a beneficial and safe regional anaesthesia technique for paediatric patients who underwent minimally invasive closure of transthoracic VSD, although prospective randomized controlled trials are needed to confirm the results.
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Affiliation(s)
- Qiong Ling
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuhua Zhao
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Yongyong Shi
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangyu Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gaofeng Zhao
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qianqian Zhu
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
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A Two-Point Ultrasound-Guided Injection Technique for the Transversus Thoracis Plane Block: A Canine Cadaveric Study. Animals (Basel) 2022; 12:ani12172165. [PMID: 36077885 PMCID: PMC9454867 DOI: 10.3390/ani12172165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary The transversus thoracis plane block is a locoregional technique recently described in canine cadavers to desensitize the intercostal nerves running through this plane. In canine cadavers, a transverse approach through a single injection point at the fifth intercostal space has been described, although consistent staining of the intercostal nerves was not completely achieved. The objective of this study was twofold: (1) to evaluate if the transverse approach is feasible at the third and sixth intercostal spaces and (2) to compare, by anatomical dissection, the spread of a dye solution and the staining of the intercostal nerves when a low volume (0.5 mL kg−1) or a high volume (1 mL kg−1) was equally divided at a two-point injection in the same hemithorax. Our results showed that the injection of the high-volume dye solution, equally injected at the third and sixth intercostal spaces using the transverse approach, achieved a consistent staining of from T2 to T7 intercostal nerves. This block could achieve adequate desensitization of the ventral chest wall during sternotomy in the dog. Clinical studies in live animals are necessary to confirm the efficacy of this technique. Abstract The transversus thoracis plane (TTP) block desensitizes the intercostal nerves that run through this plane, providing analgesia to the ventral thoracic wall. Two canine cadavers were used to assess the feasibility of the transverse approach for the TTP (t-TTP) under ultrasound guidance to inject a solution at the third and sixth intercostal spaces. Eight cadavers were used to compare the spread and number of intercostal nerves that were stained when a low volume (LV) 0.5 mL kg−1 or a high volume (HV) 1 mL kg−1 of a dye-lidocaine solution was injected into the same hemithorax, injecting the volume equally at these intercostal spaces using the transverse approach. Fisher’s exact test and Wilcoxon signed-rank test were used to contrast the spread of the different volume solutions. The injectate spread along the TTP after all injections, dying a median number (range) of 3 (2–5) and 6 (5–6) nerves with LV and HV, respectively (p = 0.011). The two-point injection of HV, using the t-TTP approach, is a feasible technique that provides a consistent staining from T2 to T7 intercostal nerves. The injection of HV instead of LV increases the spread and enhances the number of stained intercostal nerves.
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Szamborski M, Janc J, Rosińczuk J, Janc JJ, Leśnik P, Łysenko L. 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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8696. [PMID: 35886547 PMCID: PMC9320164 DOI: 10.3390/ijerph19148696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Marek Szamborski
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | | | - Patrycja Leśnik
- Department of Anesthesiology and Intensive Therapy, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland; (M.S.); (P.L.)
| | - Lidia Łysenko
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, 50-529 Wroclaw, Poland;
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Regional Anesthesia for Cardiac Surgery: A Review of Fascial Plane Blocks and Their Uses. Adv Anesth 2021; 39:215-240. [PMID: 34715976 DOI: 10.1016/j.aan.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Description of an Ultrasound-Guided Transverse Approach to the Transversus Thoracis Plane Block and Evaluation of Injectate Spread in Canine Cadavers. Animals (Basel) 2021; 11:ani11092657. [PMID: 34573624 PMCID: PMC8466234 DOI: 10.3390/ani11092657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary In humans, the aim of the transversus thoracis plane block is to desensitise the intercostal nerves running through this plane, providing analgesia to the anterior chest wall. Our objective was twofold: describing an ultrasound-guided transverse approach to the transversus thoracis plane and evaluating the spread of two injectable volumes in canine cadavers. Gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages were described in two dog cadavers. Eight cadavers were used to describe this approach and were subsequently dissected to evaluate the injectate spread and the intercostal nerves staining after low volume (0.5 mL kg−1) and high volume (1 mL kg−1) dye-lidocaine injection. After all injections, the injectable solution was distributed along the transversus thoracis plane, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with low and high volume, respectively (p = 0.014). The transverse approach to the transversus thoracis plane is a feasible, single injection point technique that provides the staining of several intercostal nerves. The injection of high versus low volume increases the number of stained nerves. Abstract Transversus thoracis plane (TTP) block has demonstrated to produce analgesia in humans undergoing median sternotomy. The objectives of the study were to describe an ultrasound-guided transverse approach to the transversus thoracis plane (t-TTP) and to evaluate the spread of two injectable volumes in canine cadavers. Two cadavers were used to describe relevant gross anatomy of the ventral thoracic area and sonoanatomy between the fifth and sixth costal cartilages. Then, eight cadavers were used to describe the ultrasound-guided injection into the TTP and were dissected to evaluate the injectate spread and the intercostal nerves staining with two different dye-lidocaine volumes: low volume (LV) 0.5 mL kg−1 and high volume (HV) 1 mL kg−1. To compare the spread between both volumes the Fisher’s exact test and Wilcoxon signed-rank test were used. The solution spread along the TTP after all injections, staining a median number (range) of 3 (2–4) and 4 (3–5) nerves with LV and HV, respectively (p = 0.014). The injection of HV versus LV increases the number of stained nerves. Ultrasound-guided t-TTP is a feasible technique that provides staining of several intercostal nerves with a single injection site, so it could be useful to provide analgesia to the ventral chest wall.
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Ahiskalioglu A, Kucun T, Yayik AM, Ulas AB, Ates İ. Ultrasound-Guided Transversus Thoracis Muscle Plane Block Provides Effective Postoperative Analgesia for Pediatric Open Pectus Carinatum Surgery: First Report. PAIN MEDICINE 2021; 22:1233-1235. [PMID: 32783064 DOI: 10.1093/pm/pnaa250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University Faculty of Medicine, Clinical Research, Development and Design Application and Research Center, Ataturk University, Erzurum, Turkey
| | - Tugberk Kucun
- Department of Anaesthesiology and Reanimation, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Murat Yayik
- Department of Anaesthesiology and Reanimation, Ataturk University Faculty of Medicine, Clinical Research, Development and Design Application and Research Center, Ataturk University, Erzurum, Turkey
| | - Ali Bilal Ulas
- Department of Thorax Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - İrem Ates
- Department of Anaesthesiology and Reanimation, Ataturk University Faculty of Medicine, Erzurum, Turkey
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Abdelbaser II, Mageed NA. Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study. J Clin Anesth 2020; 67:110002. [DOI: 10.1016/j.jclinane.2020.110002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
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Aydin ME, Ahiskalioglu A, Ates I, Tor IH, Borulu F, Erguney OD, Celik M, Dogan N. Efficacy of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Postoperative Opioid Consumption After Cardiac Surgery: A Prospective, Randomized, Double-Blind Study. J Cardiothorac Vasc Anesth 2020; 34:2996-3003. [PMID: 32665179 DOI: 10.1053/j.jvca.2020.06.044] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The postoperative analgesic efficacy of transversus thoracic muscle plane block (TTMPB) has not yet been evaluated sufficiently. This randomized controlled study evaluated the effect of TTMPB on postoperative opioid consumption in patients undergoing cardiac surgery. DESIGN Prospective, randomized, double-blind study. SETTINGS Single institution, academic university hospital. PARTICIPANTS Forty-eight adult patients having cardiac surgery with median sternotomy. INTERVENTIONS Patients were randomly assigned to receive preoperative ultrasound-guided TTMPB with either 20 mL of 0.25% bupivacaine or saline bilaterally. Postoperative analgesia was administered intravenously in the 2 groups 4 times a day with 1000 mg of paracetamol and patient-controlled analgesia with fentanyl. MEASUREMENTS AND MAIN RESULTS The primary outcome was opioid consumption in the first 24 hours. Secondary outcomes included postoperative pain scores, first analgesic requirement time, rescue analgesia, intensive care discharge time, and side effects. Compared with the control group (median 465 µg, interquartile range 415-585), the transversus thoracic muscle plane (TTMP) group (median 255 µg, interquartile range 235-305) had reduced postoperative 24-hour opioid consumption (p < 0.001). Pain scores were significantly lower in the TTMP group compared with the control group up to 12 hours after surgery both at rest and active movement (p < 0.001). Compared with the TTMP group, the proportion of postoperative nausea and pruritus was statistically higher in the control group (p < 0.001). CONCLUSIONS A single preoperative TTMPB provided effective analgesia and decreased opioid requirements in patients undergoing cardiac surgery.
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Affiliation(s)
- Muhammed Enes Aydin
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey.
| | - Irem Ates
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ibrahim Hakki Tor
- Department of Anesthesiology and Reanimation, University of Health Sciences School of Medicine, Erzurum, Turkey
| | - Ferhat Borulu
- Department of Cardiovascular Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ozlem Dilara Erguney
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Mine Celik
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey; Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
| | - Nazim Dogan
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
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Piraccini E, Byrne H, Taddei S. Pecto intercosto fascial block can be useful to treat Tietze syndrome. J Clin Anesth 2020; 64:109825. [PMID: 32305792 DOI: 10.1016/j.jclinane.2020.109825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Emanuele Piraccini
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy.
| | - Helen Byrne
- Kingsbridge Medical Diagnostics, Kingsbridge Healthcare Group, Belfast, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Stefania Taddei
- Anesthesia, Intensive Care Nord and Pain Management Unit, Bellaria Hospital, Bologna, Italy
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