Transversus Thoracic Muscle Plane Block on a Cadaver With History of Coronary Artery Bypass Grafting

Fujii, Satoru; Vissa, Deepti; Ganapathy, Sugantha; Johnson, Marjorie; Zhou, Jian

doi:10.1097/aap.0000000000000607

Cited by 33 publications

(22 citation statements)

References 7 publications

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“…Regarding the best intercostal space for this block, a study involving 10 healthy volunteers demonstrated that injection at the T4-T5 intercostal space improved the spread of local anesthetic compared with injection at T3-T4 [15]. In our cadaver study [11] injection of local anesthetic at T4-T5 resulted in spread from the manubrium to the T5-T6 intercostal space.…”

Section: Techniquementioning

confidence: 81%

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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: 81%

“…The TTP block technique has been described in the literature with some variation depending on the center and the operator [1, 11–18]. The area of analgesic coverage by the TTP block is depicted in Figure 1.…”

Section: Techniquementioning

confidence: 99%

Transversus Thoracis Muscle Plane Block

Fujii

Bairagi

Roche

et al. 2019

BioMed Research International

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“…Our group recently published a cadaveric TTP block study of a CABG patient who had an internal thoracic artery (ITA) conduit. We found the TTP block plane was surgically disrupted by ITA harvesting because the ITA courses in this plane 16. As a result, the TTP block injectate did not spread evenly between the desired thoracic levels.…”

Section: Discussionmentioning

confidence: 96%

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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“…[ 37 ] A possible limitation of TTP block may be disruption of the plane during internal mammary artery (IMA) harvesting (because the IMA courses in this plane) leading to non-spread of injectate between the desired thoracic levels. [ 38 ] Although known by different nomenclature, many of the above-mentioned blocks actually aim at anesthetizing anterior cutaneous branches. Literature in the recent past have also questioned the difference between these blocks.…”

Section: Discussionmentioning

confidence: 99%

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

Kar

Ramachandran

2020

Ann Card Anaesth

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Acute post-operative pain following sternotomy in cardiac surgery should be adequately managed so as to avoid adverse hemodynamic consequences and pulmonary complications. In the era of fast tracking, adequate and efficient technique of post-operative analgesia enables early extubation, mobilization and discharge from intensive care unit. Due to increasing expertise in ultrasound guided blocks there is a recent surge in trial of bilateral nerve blocks for pain relief following sternotomy. The aim of this article was to review non-neuraxial regional blocks for analgesia following sternotomy in cardiac surgery. Due to the paucity of similar studies and heterogeneity, the assessment of bias, systematic review or pooled analysis/meta-analysis was not feasible. A total of 17 articles were found to be directly related to the performance of non-neuraxial regional nerve blocks across all study designs. Due to scarcity of literature, comments cannot be made on the superiority of these blocks over each other. However, most of the reviewed techniques were found to be equally efficacious or better than conventional and established techniques.

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Transversus Thoracic Muscle Plane Block on a Cadaver With History of Coronary Artery Bypass Grafting

Cited by 33 publications

References 7 publications

Transversus Thoracis Muscle Plane Block

Transversus Thoracis Muscle Plane Block

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

Pain relief following sternotomy in conventional cardiac surgery: A review of non neuraxial regional nerve blocks

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