Purpose Transversus thoracic muscle plane block (TTPB) is an upcoming modality for analgesia post-sternotomy. We aimed to evaluate the effect of pre-operative TTPB on post-operative analgesia in cardiac surgical patients undergoing sternotomy. Methods Seventy patients (18–65 years) of either gender, posted for cardiac surgery needing midline sternotomy, were prospectively enrolled and block randomized into two groups of 35 each —group T (receiving TTPB) and group C (control). Post-operative analgesia was monitored using the Numerical Rating Scale (NRS) during rest, cough, and incentive spirometry. Diaphragmatic excursion and arterial blood gases (ABG) were used to measure post-operative respiratory function, along with total opioid consumption and the duration of post-operative mechanical ventilation. Results NRS at rest, during cough and spirometry was significantly lower in group T at 6, 12, and 24 h post-surgery (p < 0.0001). Bilateral diaphragmatic excursion (at rest and maximal inspiration) was reduced more in group C than group T (p < 0.0001 at 12 h and 24 h post-operatively). Mean opioid consumption in the first 24 h after surgery was much lesser in group T (232.29 µg vs 373 µg, p < 0.0001), along with a lesser need for rescue analgesia in the same group. The mean duration of mechanical ventilation was 9.31 h in group T and 11.53 h in group C (p < 0.0001). Conclusion Administering TTPB prior to midline sternotomy in cardiac surgeries is an effective way of providing post-operative analgesia. It also improves the diaphragmatic excursion, reduces opioid consumption, and aids in faster extubation. Trial registration The study has been registered with the Clinical Trials Registry of India prior to patient enrolment. (CTRI/2022/10/046536). Link to webpage- <a href="https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19">https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19</a> Date of registration: 17/10/2022. Date of first patient enrollment: 21/10/2022. Graphical Abstract

Effect of ultrasound-guided transversus thoracic plane block on post-operative analgesia in patients undergoing cardiac surgery through midline sternotomy, a randomized controlled trial

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发表日期：

2025年8月19日

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Lalthazuali,
Amita Gupta,
Ira Balakrishnan,
Khushboo Mehta,
Anubhav Gupta

摘要

Purpose

Transversus thoracic muscle plane block (TTPB) is an upcoming modality for analgesia post-sternotomy. We aimed to evaluate the effect of pre-operative TTPB on post-operative analgesia in cardiac surgical patients undergoing sternotomy.

Methods

Seventy patients (18–65 years) of either gender, posted for cardiac surgery needing midline sternotomy, were prospectively enrolled and block randomized into two groups of 35 each —group T (receiving TTPB) and group C (control). Post-operative analgesia was monitored using the Numerical Rating Scale (NRS) during rest, cough, and incentive spirometry. Diaphragmatic excursion and arterial blood gases (ABG) were used to measure post-operative respiratory function, along with total opioid consumption and the duration of post-operative mechanical ventilation.

Results

NRS at rest, during cough and spirometry was significantly lower in group T at 6, 12, and 24 h post-surgery (p < 0.0001). Bilateral diaphragmatic excursion (at rest and maximal inspiration) was reduced more in group C than group T (p < 0.0001 at 12 h and 24 h post-operatively). Mean opioid consumption in the first 24 h after surgery was much lesser in group T (232.29 µg vs 373 µg, p < 0.0001), along with a lesser need for rescue analgesia in the same group. The mean duration of mechanical ventilation was 9.31 h in group T and 11.53 h in group C (p < 0.0001).

Conclusion

Administering TTPB prior to midline sternotomy in cardiac surgeries is an effective way of providing post-operative analgesia. It also improves the diaphragmatic excursion, reduces opioid consumption, and aids in faster extubation.

Trial registration

The study has been registered with the Clinical Trials Registry of India prior to patient enrolment.

(CTRI/2022/10/046536).

Link to webpage-

https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19

Date of registration: 17/10/2022.

Date of first patient enrollment: 21/10/2022.

Graphical Abstract