Transversus Thoracis Muscle Plane Block for Postoperative Pain in Adult Cardiac Surgery

Muğla Sıtkı Koçman University

Status: Completed

Conditions: Postoperative Pain; Coronary Artery Bypass; Chest Pain; Sternotomy

Treatments: Procedure: Transversus Thoracic Muscle Plane Block; Procedure: Parasternal Intercostal Plane Block

Study type: Interventional

Funder types: Other

Identifiers

NCT04591119

MSKU 20-IV

Details and patient eligibility

About

Inadequate pain control after coronary artery bypass graft surgery increases mortality and results in a higher incidence of persistent poststernotomy pain syndrome. Our aim is to assess whether ultrasound-guided parasternal intercostal block (PSIB) or surgeon implied transversus thoracic muscle plane block (TTMPB) would improve the postoperative pain scores and decrease tramadol consumption better after coronary artery bypass graft surgery

Enrollment: 75 patients

Sex: All

Ages: 45 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• American Society of Anesthesiologists physical status II-III
• Elective coronary artery bypass graft surgery under general anesthesia

Exclusion criteria

• American Society of Anesthesiologists physical status IV
• Emergency surgery and redo surgery
• Low cardiac output syndrome, perioperative intra-aortic balloon pump support for any reason, bleeding disorder or abnormal coagulation profile, abnormal hepatic and renal parameters, uncontrolled diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation on anticoagulation
• Allergy to any study drugs, local infection at the block site
• Opioid abuse

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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75 participants in 3 patient groups

Transversus Thoracic Muscle Plane Block (TTMPB) Group

Active Comparator group

Description:

At the TTMPB group, the block will be performed by the surgeon before the closure of the sternum by visualizing the muscles and identifying them. In the TTMPB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between internal intercostal muscle and transversus thoracic muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space.

Treatment:

Procedure: Transversus Thoracic Muscle Plane Block

Parasternal Intercostal Block (PSIB) Group

Active Comparator group

Description:

At the PSIB group, the block will be performed by ultrasound guidance after completion of surgery. PSIB Blocks will be performed under ultrasonography guidance using a linear 6 to 13 megahertz ultrasound probe by the anesthesist.In PSIB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between psoas major muscle and external intercostal muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space bilaterally.

Treatment:

Procedure: Parasternal Intercostal Plane Block

Control Group

No Intervention group

Description:

At the control group, no intervention for pain management will be done.