Ultrasound Guided Transversus Thoracic Plane block, Parasternal block and fascial planes hydrodissection for internal mammary post thoracotomy pain syndrome

Piraccini, Emanuele; Biondi, Giovanni; Byrne, Helen; Calli, Morena; Bellantonio, Daniele; Musetti, Giovanni; Maitan, Stefano

doi:10.1002/ejp.1249

Cited by 33 publications

(21 citation statements)

References 25 publications

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“…The available literature demonstrates the use of TTP blocks in breast resection surgery, subcutaneous internal cardiac defibrillator placement [10], and pericardial effusion drainage [21]. Other applications include acute pain management associated with sternal fractures [22] and chronic pain treatment for postthoracotomy internal mammary pain syndrome [12].…”

Section: Current Indications and Available Evidencementioning

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: Current Indications and Available Evidencementioning

confidence: 99%

“…Piraccini et al described the use of a different parasternal block with the TTP block to treat a patient suffering from postthoracotomy internal mammary pain syndrome ten months after surgery [12]. Pecs blocks do not provide analgesia to the internal mammary region, whereas the parasternal and TTP blocks do.…”

Section: Current Indications and Available Evidencementioning

confidence: 99%

Transversus Thoracis Muscle Plane Block

Fujii

Bairagi

Roche

et al. 2019

BioMed Research International

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“…[ 6 7 ] TTM is also used in combination with parasternal block to treat the residual post-thoracotomy pain syndrome. [ 8 ] There has been limited literature on the combination of PECS1 with a TTM block for CIED insertion procedures. Hence, the present study was conducted to compare the analgesic efficacy of PECS1 block with combined PECS1 and TTM block in patients undergoing CIED insertion.…”

Section: Introductionmentioning

confidence: 99%

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Nagaraja¹,

Arasu²,

Ragavendran³

et al. 2020

Ann Card Anaesth

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Background: Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. Materials and Methods: Thirty adult patients between the age group of 18–85 years undergoing CIED insertion were enrolled in the study. A prospective, randomized, comparative, pilot study was conducted. A total of 30 patients were enrolled, who were randomized to either Group P: PECS1 block ( n = 15) or Group PT: PECS1 and TTM blocks ( n = 15). The intraoperative requirement of midazolam and local anesthetic and level of sedation by Ramsay sedation score were noted. The pain was assessed by visual analog scale (VAS) at rest and during a cough or deep breathing at 0 h, 3 h, 6 h, 12 h, and 24 h after the procedure. Results: VAS scores at rest were significantly lower in group PT at 0, 3, 6, and 12 h postprocedure, and during cough at 0, 6, and 12 h after the procedure ( P < 0.05). At 24 h, VAS scores were comparable between both groups. Intraoperative midazolam consumption was higher in group P compared to group PT ( P = 0.002). Fourteen patients in group P received local anesthetic supplementation in comparison to only one patient in group PT ( P = 0.0001). Thirteen patients in group P received the first rescue analgesia in comparison to three patients in group PT ( P = 0.0003). Conclusion: Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.

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“…[ 4 ] The same author reported one case with right postthoracotomy pain syndrome received the hydrodissection of fascial planes in the internal mammary region with triamcinolone and ropivacaine together with a nerve block. [ 5 ] Ueshima reported that using local anesthetic into the fascial plane between the multifidus and longissimus muscles among two patients who underwent spinal surgery can improve patients' recovery. [ 6 ] Ueshima also recently reported that normal saline 10 mL between the fascia of the internal and external intercostal muscles can successfully relieve pain; however, Ueshima proposed that interfascial adhesion is the cause of pain.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided physiological saline injection for patients with myofascial pain

et al. 2020

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Background: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. Materials and Methods: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. Results: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. Conclusion: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.

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Ultrasound Guided Transversus Thoracic Plane block, Parasternal block and fascial planes hydrodissection for internal mammary post thoracotomy pain syndrome

Abstract: The use of Transversus Thoracic Plane and Parasternal Blocks and fascial planes hydrodissection as a novel therapeutic approach to treat a residual post thoracotomy pain syndrome even when already treated with Pectoral Nerves Block and Serratus Plane Block.

Cited by 33 publications

References 25 publications

Transversus Thoracis Muscle Plane Block

Transversus Thoracis Muscle Plane Block

Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion – A pilot study

Ultrasound-guided physiological saline injection for patients with myofascial pain

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