Parasternal, Pecto-intercostal, Pecs, and Transverse Thoracic Muscle Plane Blocks

Buono, Romualdo Del; Costa, Fabio; Agrò, Felice Eugenio

doi:10.1097/aap.0000000000000464

Cited by 35 publications

(22 citation statements)

References 5 publications

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“…Since this muscle layer is thin and adjacent to the pleura, there is a risk of pleural puncture. Recently, Ohgoshi et al 17 and Del Buono et al 18 described the parasternal intercostal nerve block as a safer alternative to the TTP block, as the plane to be blocked is more superficial. Although this block has not been clinically used yet, it may be an effective alternative for patients with a history of ITA harvest.…”

Section: Discussionmentioning

confidence: 99%

Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study

Fujii

Roche

Jones

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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IntroductionCardiac surgery patients often experience significant pain after median sternotomy. The transversus thoracis muscle plane (TTP) block is a newly developed, single-shot nerve block technique that provides analgesia for the anterior chest wall. In this double-blind pilot study, we assessed the feasibility of performing this novel block as an analgesic adjunct.MethodsAll patients aged 18–90 undergoing elective cardiac surgery were randomized to the block or standard care control group on admission to the intensive care unit after surgery. Under ultrasound guidance, patients in the block group received the TTP block with 20 mL of either 0.3% or 0.5% ropivacaine bilaterally, based on weight. The control group did not receive any injections. All blocks were performed by a single anesthesiologist, and data collection was performed by blinded assessors. The primary feasibility outcomes were rate of recruitment, adherence, and adverse events. The rate of recruitment was defined as the ratio of patients giving informed consent to the number of eligible patients who were approached to participate. Secondary outcomes included 12-hour and 24-hour Numeric Rating Scale (NRS) pain scores, 24-hour hydromorphone and acetaminophen requirements, time to extubation, time to first opioid administration, and patient satisfaction (on a yes/no questionnaire) at 24 hours.ResultsTwenty patients were approached for this study and 19 were enrolled. Eight patients received the intended intervention in each group. The recruitment rate was 95% of all approached eligible patients, and the adherence rate to treatment group was 94%. There were no block-related adverse events. The mean (SD) NRS pain scores at rest were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control group at 12 hours. At 24 hours, the pain scores were 4.1 (3.9) vs 4.1 (3.3) in the block and control group, respectively. The mean (SD) 24-hour hydromorphone administration was 1.9 (1.1) mg in the block group vs 1.8 (0.9) mg in the control group.DiscussionThe TTP block is a novel pain management strategy poststernotomy. The results reveal a high patient recruitment, adherence, and satisfaction rate, and provide some preliminary data supporting safety.Trial registration number NCT03128346.

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Section: Discussionmentioning

confidence: 99%

Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study

Fujii

Roche

Jones

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…We routinely perform regional anaesthesia for breast procedures using a combination of the three techniques [4]: PECS‐2 block: to cover muscles, axilla and lateral cutaneous branches of intercostal nerves (reliably from T2 to T4) Serratus plane block: to cover lateral cutaneous branches from T4 to T7 Any technique to cover anterior cutaneous branches, as the parasternal block [5] or the transversus thoracis muscle plane block [2] …”

Section: Figurementioning

confidence: 99%

Breast surgery analgesia: another perspective for PROSPECT guidelines

et al. 2020

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“…However, a saturation point may have been reached, as some authors have started to wonder if all the new truncal blocks are really distinct, and if some do not simply constitute variations of the same entity. [83][84][85][86] …”

Section: Limitations Of Ultrasound Guidancementioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

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Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation.Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report).

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Parasternal, Pecto-intercostal, Pecs, and Transverse Thoracic Muscle Plane Blocks

Cited by 35 publications

References 5 publications

Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study

Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study

Breast surgery analgesia: another perspective for PROSPECT guidelines

Beyond Ultrasound Guidance for Regional Anesthesiology

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