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ABSTRACT
Background
Patients undergoing heart surgery with a midline sternotomy typically get intravenous opioids as their primary form of post-operative pain management. Due to its possible drawbacks, regional neuraxial anesthesia is still controversial. There have been reports on the impact of rectus sheath plane (RSP) block in conjunction with ultrasound-guided transverse thoracic muscle plane (TTP) block on postoperative pain following sternotomy.
Aim Of The Study
The efficiency of combining TTP and RSP blocks in lowering the targeted patients’ perioperative requirement for opioids, minimizing opioid adverse effects, and attaining a potential Fast-Tract Extubation.
Patients And Methods
50 patients undergoing open cardiac surgery via median sternotomy were randomly assigned to one of two groups in this randomized, prospective, comparative trial. Group (B) got combined ultrasound-guided TTP and RSP blocks, while Group (S) received saline in the same planes before to the incision.
Results
There was no significant difference between the groups for the demographic information, postoperative opioid consumption, or VAS pain scores, however there was a very significant difference between the groups for intraoperative opioid intake and time to extubation.
Conclusion
Combining TTP and RSP blocks has improved fast-track extubation, decreased hemodynamic changes in response to surgical stress, and decreased intraoperative opioid usage. The blocks directed by routine pain score evaluation did not, however, have a significant impact on postoperative opioid use.
Abbreviations
| ASA | = | American Society of Anesthesiology |
| CABG | = | Coronary Artery Bypass Graft |
| CPB | = | Cardio-Pulmonary Bypass |
| CVC | = | Central Venous Catheter |
| ETCO2 | = | End Tidal CO2 |
| ETT | = | Endo-Tracheal Tube |
| FiO2 | = | Fraction of Inspired Oxygen |
| HR | = | Heart Rate |
| IABP | = | Intra-Aortic Balloon Pump |
| IBP | = | Invasive Blood Pressure |
| ICU | = | Intensive Care Unit |
| IMA | = | Internal Mammary Artery |
| LA | = | Local Anesthetic |
| mcg | = | Microgram |
| mg | = | Milligram |
| MV | = | Mechanical Ventilation |
| NRS | = | Numerical Rating Scale |
| POD | = | Postoperative Day |
| PPV | = | Positive-Pressure Ventilation |
| RSP | = | Rectus Sheath Plane |
| SBP | = | Systolic Blood Pressure |
| SD | = | Standard Deviation |
| TTP | = | Transverse Thoracic muscle Plane |
| VAP | = | Ventilator-Associated Pneumonia |
| VAS | = | Visual Analogue Score |
Acknowledgments
First of all, all gratitude is due to God’s blessing for achieving this work until it has reached its end, as a part of his generous help and care throughout my life.
I would like to thank my dear professor Prof. Dr. Alaa Eid, Professor of the Anesthesiology, Intensive care and Pain Medicine at Ain Shams University for he had consistently allowed this paper to be my own work, but steered me in the right the direction whenever he thought I needed it.
Thanks also must be given to Prof. Dr. Fahmy Saad, Professor of Anesthesiology, Intensive Care and Pain Medicine at Ain Shams University for his warm welcoming and great support to direct me through my thesis study, and allocating time to enrich this work.
I would also like to thank my work advisor who was involved in the validation survey for this research project Dr. Riham Fathy, Lecturer of Anesthesiology, Intensive care and Pain Medicine at Ain Shams University. Without her passionate participation and input, the validation survey could not have been successfully conducted.
Finally, I must express my very profound gratitude to my family, my friends, and my colleagues for providing me with unfailing support and continuous encouragement throughout this year of my study and through the process of researching and writing this paper. This accomplishment would not have been possible without them.
Disclosure statement
No potential conflict of interest was reported by the author(s).