Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery

Yamamoto, Tohei; Seino, Yutaka; Matsuda, Keita; Imai, Hidekazu; Bamba, Keiko; Sugimoto, Ai; Shiraishi, Shuichi; Schindler, Ehrenfried

doi:10.1053/j.jvca.2020.07.041

Cited by 19 publications

(15 citation statements)

References 28 publications

(33 reference statements)

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“…An interesting variation of the technique was described by Yamamoto et al, 8 proposing a preoperative combination of transversus thoracic plane block (TTPB) and RSB for postoperative pain relief after cardiac surgery with sternotomy in paediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

Toscano

Balzani

Capuano

et al. 2022

Journal of Cardiac Surgery

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Background: Postoperative pain after cardiac surgery is a very important issue and affects recovery, risk of postoperative complications and quality of life. The pain management has been traditionally based on intravenous opioids with growing evidence suggesting the use of opioid-free and opioid-sparing techniques to reduce its adverse effects.Case Presentation: We report the case of a 75-year-old frail patient underwent awake mediastinal revision with subxiphoid access due to deep sternal wound infection using a pectoralis-intercostal rectus sheath (PIRS) plane block. During the procedure the patient never reported pain receiving acetaminophen 1 g every 8 h for postoperative pain management without others pain relievers. Conclusion:Ultrasound guided PIRS block could be an effective and safe analgesic technique to manage sternal and subxiphoid drainage pain in patients undergoing cardiac surgery via subxiphoid approach.

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Section: Discussionmentioning

confidence: 99%

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

Toscano

Balzani

Capuano

et al. 2022

Journal of Cardiac Surgery

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“…The target of the peripheral nerve block for a median sternotomy or intercostal incision is the anterior/ventral branches of the spinal cord, that is, the intercostal nerves. The intercostal nerves arise from the anterior rami of the thoracic spinal nerves and run between the innermost and inner intercostal muscles, branching off collateral and lateral cutaneous branches along the way, and finally become anterior cutaneous branches and are distributed in the lateral and front sides of the chest wall, respectively, innervating sensory supply to the skin, soft tissue, and muscle on the anterior aspect of the trunk, including the sternum [ 34 , 35 ▪ , 36 ▪ , 37 ▪ ]. Consequently, blocking the intercostal nerve at any approachable site is the theory of peripheral nerve block for cardiac surgery with median sternotomy, as well as the intercostal approach (Fig.…”

Section: Pain Therapy Beyond Systemic Opioids For Pediatric Cardiac S...mentioning

confidence: 99%

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

Yamamoto

Schindler

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThe purpose of this review article was to highlight the enhanced recovery protocols in pediatric cardiac surgery, including early extubation, rapid mobilization and recovery, reduction of opioid-related side effects, and length of pediatric ICU and hospital stay, resulting in decreased costs and perioperative morbidity, by introducing recent trends in perioperative anesthesia management combined with peripheral nerve blocks.Recent findingsEfficient postoperative pain relief is essential for realizing enhanced recovery strategies, especially in pediatric patients. It has been reported that approaches to perioperative pain management using additional peripheral nerve blocks ensure early extubation and a shorter duration of ICU and hospital stay. This article provides an overview of several feasible musculofascial plane blocks to achieve fast-track anesthesia management for pediatric cardiac surgery.SummaryRecent remarkable advances in combined ultrasound techniques have made it possible to perform various peripheral nerve blocks. The major strategy underlying fast-track anesthesia management is to achieve good analgesia while reducing perioperative opioid use. Furthermore, it is important to consider early extubation not only as a competition for time to extubation but also as the culmination of a qualitative improvement in the outcome of treatment for each patient.

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“…Concerning subxiphoid pain related to epigastric chest tubes, Sepolvere et al observed positive results regarding pain and pulmonary capacity in a case series following cardiac surgery patients postoperatively who received rectus sheath (RS) blocks [3]. Yamamoto et al describe encouraging observational results when combining TTP and RS blocks preoperatively in the pediatric cardiac surgery population [6]. However, these novel analgesic blocks have not been studied extensively in conjunction with each other in adults undergoing cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Bilateral Rectus Sheath Blocks in Conjunction With Transversus Thoracis Plane and Pectointercostal Fascial Blocks for Immediate Postoperative Analgesia After Cardiac Surgery

Everett¹,

Davis²,

Deshpande³

et al. 2022

Cureus

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Pain continues to be a well-known complication of cardiac surgery in the postoperative period and intravenous opioid analgesia has traditionally been employed to manage cardiac surgical pain. However, both components have contributed to a multitude of undesirable adverse effects which can further exacerbate delays in recovery. Often overlooked in the analgesic plan, chest tube pain contributes significantly to the overall postoperative pain from cardiac surgery. Novel regional anesthetic blocks have shown great promise as analgesic adjuncts for cardiothoracic anesthesia but preliminary investigations focus primarily on management of sternotomy pain. Reduction of chest tube pain should be considered while implementing regional blocks to control surgical pain. This study presents a case where the rectus sheath block minimized chest tube pain after aortic valve replacement in conjunction with intercostal nerve blocks and a multimodal analgesic plan.

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Preoperative Implementation of Transverse Thoracic Muscle Plane Block and Rectus Sheath Block Combination for Pediatric Cardiac Surgery

Cited by 19 publications

References 28 publications

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

Awake cardiac surgery using the novel pectoralis‐intercostal‐rectus sheath (PIRS) plane block and subxiphoid approach

Regional anesthesia as part of enhanced recovery strategies in pediatric cardiac surgery

Implementation of Bilateral Rectus Sheath Blocks in Conjunction With Transversus Thoracis Plane and Pectointercostal Fascial Blocks for Immediate Postoperative Analgesia After Cardiac Surgery

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