Comparative Study between Ultrasound- Guided Transversus Thoracis Muscle Plane Block versus Pecto-intercostal Fascial Block for Perioperative Pain Management in Open Cardiac Surgery Patients | ||||
| Al-Azhar International Medical Journal | ||||
| Volume 2024, Issue 12, December 2024 | ||||
| DOI: 10.58675/2682-339X.2735 | ||||
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| Authors | ||||
| Ammar Khedr1; Ayman kahla1; Ahmed El Naggar1; Bahaa Elkhonezy2 | ||||
| 1Anesthesiology, Intensive Care and Pain management, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt | ||||
| 2Cardiothoracic, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: Patients undergoing open-heart surgeries often report inadequate pain treatment after the procedure. Safe regional blocks such as the thoracic muscle plane block (TTPB) and the pecto-intercostal fascia block (PIFB) can accelerate the healing process after heart surgery. Perioperative pain treatment during open heart surgery with a median sternotomy was the focus of this study, which compared ultrasound-guided TTPB to PIFB. Aime: To assess the effectiveness and safety of ultrasound-guided TTPB compared to PIFB in managing perioperative pain in open heart surgery with a median sternotomy. Methods: This study was conducted as a randomized, prospective, double-masked clinical trial including 60 adult patients between the ages of 21 and 65. The patients of either sex were having non-emergent heart surgery using median sternotomy. The patients are separated into two groups of equal size: Group (TTPB): Ultrasound-guided bilateral transverse thoracic plane block, and Group (PIFB): Ultrasound-guided bilateral parasternal intercostal fascial block. Results: There was a significant increase in NRS in the two groups over the periods, but the most increase in NRS is in the PIFB Group compared to the TTPB Group At 30 min, after 6 and 12 hrs (p<0.05). Morphine consumption was 10.81±2.27 in the TTPB group and 14.28±3.05 in the PIFB group. Morphine consumption, time to first rescue analgesia after extubation, and time to extubate were significantly higher in the PIFB Group compared to the TTPB Group (P<0.05). Intensive care unit (ICU) length of stay and inotropic drugs significantly differed between groups. No patient needs adrenaline infusion or dopamine infusion. Only oral antihypertensive was started after stabilization of hemodynamics, usually after two hours post-extubation, when oral intake was rescued. Only a low dose of norepinephrine was used on both groups for the first four hours of ICU admission and was statically insignificant as regards dose and duration. Conclusions: Transversus thoracic muscle plane block provides a more effective strategy for perioperative pain management than PIFB in open cardiac surgery. | ||||
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