Transversus thoracis muscle plane block and parasternal block

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

“…17 The biggest advantage of the TTP block compared with PSB is the widespread coverage of multiple anterior branches of the intercostal nerves. 18,19 Because the transverse thoracic muscle lies on the inner surface of the front wall of the thoracic cage, covering the outer edge of the sternum and costal cartilages, the injected local anesthetic can spread across the multiple intercostal spaces. As a result of this spread of the local anesthetic along the TTP, it does not require as many punctures as does the PSB and it is not necessary for the puncture needle to advance close to the lower edge of the rib (where the intercostal nerve, artery, and vein are located), 20 which would entail a risk of nerve injury or bleeding.…”

Avoiding the Internal Mammary Artery During Parasternal Blocks: Ultrasound Identification and Technique Considerations

“…13 Since its introduction, the TTP block has been used for a wide range of surgical procedures and nonsurgical indications. 14 US-PSB and TTP are performed in the region of the internal mammary artery and could be considered for the treatment of residual post-thoracotomy pain syndrome. 15…”

Regional analgesia in Cardiac anesthesia: Welcoming a new era in perioperative pain management.

“…A contributing factor to the difficulty finding literature for these type of blocks is the description of the technique by the authors. A good example is the TTMP block where the local anesthetic is deposited in the TTMP block is similar to the described approach for the parasternal nerve block [3,4]. Nomenclature aside, Kar and Ramachandran showed there are few prospective randomized control studies published on newer non-neuraxial regional techniques for postoperative pain control after cardiac surgery [2].…”