Transverse Thoracic Muscle Plane Block

Murata, Hiroaki; Hida, Kumiko; Hara, Tetsuya

doi:10.1097/aap.0000000000000374

Cited by 34 publications

(12 citation statements)

References 4 publications

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“…Murata et al reported [19] that the downward movement of the pleura is a good indication of successful injection into the TTP, whereas the spread of injectate above the costal cartilage indicates the injection is above the internal intercostal muscle. After block completion, the patient is closely monitored for 20 minutes for local anesthetics toxicity, hemodynamic instability, and allergic reaction.…”

Section: Techniquementioning

confidence: 99%

“…The PSI block [28] and PIFB [29] also refer to identical techniques (Figure 3(b)). Furthermore, the TTP block itself has multiple names, such as the transversus thoracic plane block [2], transversus thoracic muscle plane block [19], and transversus thoracis muscle plane block [27]. Further clarification and standardization of the nomenclature are needed to facilitate accurate communication amongst care providers, researchers, and authors.…”

Section: Future Directionsmentioning

confidence: 99%

“…Moreover, recently published feasibility study by Fujii et al [27] shows the potential benefit and feasibility of this technique in the cardiac surgery setting. As previously stated by other authors, randomized controlled trials are necessary to explore the utility of this technique for different surgical applications [19, 27].…”

Section: Future Directionsmentioning

confidence: 99%

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Transversus Thoracis Muscle Plane Block

Fujii

Bairagi

Roche

et al. 2019

BioMed Research International

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The transversus thoracis muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. Since its introduction, this technique has been utilized for a wide range of surgical procedures as well as nonsurgical indications. Current evidence suggests that the TTP block provides effective analgesia for breast and cardiac surgeries, cardiac device implantation, pericardiocentesis, and acute and chronic pain management. To date, no major complications have been reported. Currently there is an urgent need to standardize the nomenclature of this technique to facilitate accurate communication amongst care providers, researchers, and authors. In this review, we describe the TTP block technique, review the indications and available evidence in clinical practice, and discuss alternative blocks and future prospects.

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Section: Techniquementioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

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Transversus Thoracis Muscle Plane Block

Fujii

Bairagi

Roche

et al. 2019

BioMed Research International

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“…The transversus thoracis plane block (TTPB) is a regional anesthetic method for relieving post-sternotomy pain. The local anesthetic is administered as a single shot into the myofascial plane between the transversus thoracis muscle and the internal intercostal muscles in order to block the anterior branches of Th2-Th6 intercostal nerves [51][52][53].…”

Section: Transversus Thoracis Plane Blockmentioning

confidence: 99%

Regional anesthesia for cardiothoracic surgery

2022

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Cardiac and thoracic surgery have been connected to high perioperative opioid use for a long time. With increasing knowledge of regional anesthesia in the thoracic region, thoracic nerve blocks have become supplemental methods of analgesia. As part of multimodal analgesia, they are important factors of enhanced recovery after surgery and contribute to a diminished opioid use. Myofascial nerve blocks are more superficial than the classic thoracic epidural anesthesia or paravertebral block and are therefore safer for use in anticoagulated patients. In this article, we present a number of thoracic blocks; the paraneuraxial paravertebral block; the myofascial plane blocks which are the retrolaminar block, the erector spinae plane block, the serratus anterior plane block, the pectoral nerves I and II block, the transversus thoracis plane block and the parasternal intercostal nerve block; the perineural intercostal nerve block and also local anesthetic infusion by a wound catheter. We conclude with local experience from a cardiac and thoracic surgical center.

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“…Advantage: Both these blocks anaesthetise the medial side of the breast which may be spared with SAP or Pecs blocks. Therefore, if extensive dissection of the medial side of the breast is needed PIFB or TTPB may need to be combined with the Pecs or SAP block to provide analgesia [34] (Figure 7).…”

Section: Pecto-intercostal Fascial Block (Pifb) and Transversus Thoracic Plane Block (Ttpb)mentioning

confidence: 99%

Regional Anaesthesia for Breast Surgery

2021

IJRA

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Innervation of the breast:nd thThe breast receives innervation mainly from the 2 to 6 thoracic (T2-6) spinal nerves. The thoracic spinal nerves after emerging from the intervertebral foramina divide into dorsal and ventral ramii [1]. The dorsal ramii provide innervation to the skin and the muscles of the medial back. Each ventral ramus continues anteriorly as an intercostal nerve, accompanied by an intercostal artery and vein lying between the innermost and the internal intercostal muscle along the inferior borders of the respective ribs.Near the midpoint of the hemithorax corresponding to the midaxillary line, each intercostal nerve gives a lateral cutaneous branch that further divides into an anterior and posterior branch. Sensory supply of lateral aspect of breast is provided by the anterior divisions of the lateral cutaneous branches of T2-T6 intercostal nerves with contributions from T1 and T7 nerves. The intercostal nerves interconnect providing overlapping nerve supply to the breast. The main intercostalnerve continues anteriorly and terminates as an anterior cutaneous branch that further divides into a medial and lateral divisions which provide cutaneous innervation over the sternum and medial part of the breast respectively [2-4] (Figure 1) [5].The intercostobrachial nerve (T2) mainly provides cutaneous innervation to the axillary tail of the breast, the axilla, and the medial upper arm. The medial cutaneous nerve of the arm (branch of the brachial plexus) may also supply the roof of the axilla and may receive contributions from T1 and T3 nerves. The supraclavicular nerves of the cervical plexus provide sensory supply to the infraclavicular or supramammary area [6, 7], (Figure 1). The muscles of chest wall underlying the breast, the pectoralis major (PMM) and pectoralis minor (PmM) are innervated by mixed motor and sensory nerves, the lateral pectoral nerves (LPN) (C5-7, lateral cord) and the medial pectoral nerves (MPN) (C7-T1, medial cord), branches of the brachial plexus. These nerves also possess proprioceptive and nociceptive fibres and thus traction, stretching or muscle spasm of these muscles can lead to dull, aching perioperative pain. In addition, the long thoracic nerve (LTN) (C5-7) and the thoracodorsal nerve (TDN) (C6-8, posterior cord) branches of the brachial plexus innervate the serratus anterior (SAM) and the latissimus dorsi (LD) muscles, that form part of the axilla [8]. Therefore, the breast, axilla and the surrounding tissues are supplied by interconnected network of T2-T6 intercostal nerves, branches of the brachial plexus and the lower branches of the cervical plexus (Figure 1) [5].Regional anaesthesia blocks used for Breast surgery: These blocks will be decribed starting from the older, posteriorly performed blocks to the newer, superficial antero-lateral chest wall blocks for breast surgery. Thoracic Epidural Anaesthesia (TEA)Thoracic epidural block performed at T4 has been used to provide segmental anaesthesia and analgesia extending from C8-T6 for breast surgery.Advantages of TE...

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Transverse Thoracic Muscle Plane Block

Cited by 34 publications

References 4 publications

Transversus Thoracis Muscle Plane Block

Transversus Thoracis Muscle Plane Block

Regional anesthesia for cardiothoracic surgery

Regional Anaesthesia for Breast Surgery

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