Ultrasound-Guided Transverse Thoracic Muscle Plane Block (TTMPB) for Post-Sternotomy Pain: A Randomised Controlled Trial
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background Poorly controlled acute surgical pain after cardiac surgery results from extensive tissue injuries and associated with high pain intensity and leading to chronic pain and excessive opioid use. The aim is to analyse the pain scores, patient controlled analgesia (PCA) fentanyl requirement and spirometry values in Transverse Thoracic Muscle Plane Block (TTMPB) vs. conventional opioid strategy in patients who underwent cardiac sternotomy surgeries. Methods This is a randomised controlled trial involving 40 adult patients who underwent elective cardiac surgery with sternotomy, receiving either TTMPB (B,= 20) or control (A,= 20). We measured mean pain scores at rest and on movement postextubation using the Visual Analogue Scale (VAS), mean PCA fentanyl consumption, and incentive spirometry volume at 0, 3, 6, 12, 18, 24, and 48 h postextubation. Analysis was done using the repeated measure ANOVA. Results At rest, there was a significant reduction in pain score across different time points observed between both groups (F [6, 228] = 3.180,< 0.05). On movement, a significant interaction between the TTMPB treatment and pain score at movement across different time points (F [6, 228] = 2.249,< 0.001) was shown. There was also a significant reduction in PCA fentanyl consumption across different time points (F [6, 228] = 2.080,< 0.05). Similar outcomes were also observed in spirometry volume changes across time points between the two study groups (F [6, 228] = 10.855,< 0.001). Co
Abstract
Background Poorly controlled acute surgical pain after cardiac surgery results from extensive tissue injuries and associated with high pain intensity and leading to chronic pain and excessive opioid use. The aim is to analyse the pain scores, patient controlled analgesia (PCA) fentanyl requirement and spirometry values in Transverse Thoracic Muscle Plane Block (TTMPB) vs. conventional opioid strategy in patients who underwent cardiac sternotomy surgeries. Methods This is a randomised controlled trial involving 40 adult patients who underwent elective cardiac surgery with sternotomy, receiving either TTMPB (B,= 20) or control (A,= 20). We measured mean pain scores at rest and on movement postextubation using the Visual Analogue Scale (VAS), mean PCA fentanyl consumption, and incentive spirometry volume at 0, 3, 6, 12, 18, 24, and 48 h postextubation. Analysis was done using the repeated measure ANOVA. Results At rest, there was a significant reduction in pain score across different time points observed between both groups (F [6, 228] = 3.180,< 0.05). On movement, a significant interaction between the TTMPB treatment and pain score at movement across different time points (F [6, 228] = 2.249,< 0.001) was shown. There was also a significant reduction in PCA fentanyl consumption across different time points (F [6, 228] = 2.080,< 0.05). Similar outcomes were also observed in spirometry volume changes across time points between the two study groups (F [6, 228] = 10.855,< 0.001). Conclusion The administration of the TTMPB resulted in significantly reduced pain scores at rest and movement, reduced the mean PCA fentanyl consumption and showed better incentive spirometry volume postextubation compared to the control group. This study supports TTMPB as efficient postoperative analgesia for post-cardiac surgery.