Bilateral Transversus Thoracic Muscle Plane Block as Analgesic in Open Heart Surgeries by US.

Author(s):  
Keyword(s):  
2021 ◽  
Author(s):  
Mohamed Ahmed Hamed ◽  
Maged Labib Boules ◽  
Mina Mahrous Sobhy ◽  
Mahdy Ahmed Abdelhady

Abstract Background: We aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral Transversus Thoracic Muscle Plane Block after Open-Heart Surgeries. Methods: 70 patients aged above 18 years and scheduled for valve replacement or adult congenital via median sternotomy were enrolled in this study. Patients were divided into two groups, randomized by computer-generated random numbers: the block group, which had the ultrasound-guided bilateral transversus thoracic muscle plane block, and the control group, which had a sham block. The primary outcome was total fentanyl consumption in the first 24-hours. The secondary outcomes were pain score, time to the first analgesic request, time to extubation , ICU stays, and hospital stay. Results: The total fentanyl consumption in the first 24 hours was significantly lower in the block group, with a mean difference of -158.286 (95% CI = (-179.271 to -137.300; p=<0.0001). The time to the first analgesic request was statistically significantly shorter in the non-block group (median 3 hours) than the block group (median 14 hours). During the postoperative period (0.5-24 hours), at-rest pain scores were 1.86 units lower in the block group (the estimate was -1.80, 95% CI = -2.14 to -1.45, t = -10.323 with p <0.0001). Likewise, pain scores with cough were 3.29 units lower in the block group (the estimate was -3.29, 95% CI = -3.80 to -2.77, t = -12.703, p <0.0001).Conclusion: Bilateral Transversus Thoracic Muscle Plane Block is a promising and effective technique in reducing opioid consumption and controlling post-sternotomy pain after open-heart surgery via median sternotomy.Trial Registration: This study is registered on ClinicalTrials.gov (NCT04116554; principal investigator: Mohamed Ahmed Hamed; date of registration: October 4, 2019).


1978 ◽  
Vol 39 (02) ◽  
pp. 474-487 ◽  
Author(s):  
E R Cole ◽  
F Bachmann ◽  
C A Curry ◽  
D Roby

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.


1967 ◽  
Vol 18 (03/04) ◽  
pp. 634-646 ◽  
Author(s):  
N Thurnherr

SummaryBlood clotting investigations have been executed in 25 patients who have undergone open heart surgery with extracorporeal circulation. A description of alterations in the activity of blood clotting factors, the fibrinolytic system, prothrombin consumption and platelets during several phases of the operation is given.


2007 ◽  
Vol 55 (S 1) ◽  
Author(s):  
N Madershahian ◽  
T Wittwer ◽  
J Strauch ◽  
J Wippermann ◽  
UFW Franke ◽  
...  

2015 ◽  
Vol 16 (2) ◽  
pp. 78
Author(s):  
Umit Kervan ◽  
Anil Ozen ◽  
Utku Unal ◽  
Irfan Tasoglu ◽  
Mahmut Mustafa Ulas ◽  
...  

<p><b>Objective:</b> The aim of this study was to examine the effects of positive inotropic drugs, including adrenaline, dopamine, and dobutamine on thyroid hormone levels following open heart surgery.</p><p><b>Methods:</b> We analyzed free thyroid hormones (FT3 and FT4) and thyroid-stimulating hormones (TSH) in 200 consecutive patients undergoing open heart surgery. Patients were divided into 5 groups according to the inotropic drug administration as follows: Group A (n = 46) received dopamine alone; Group B (n = 40), dopamine and dobutamine; Group C (n = 36), dopamine, dobutamine, and adrenaline; Group D (n = 32), adrenaline alone; and Group E (n = 46), placebo. Procedural factors affecting thyroid hormones were recorded and included cardiopulmonary bypass (CPB) time, cross-clamping time, degree of hypothermia, and the duration and doses of positive inotropic drugs. Blood samples for hormone assays were collected before initiation of inotropic drug therapy (baseline) and postoperatively at 24, 72, and 120 hours after drug therapy.</p><p><b>Results:</b> FT3, FT4, and TSH levels at baseline were similar in all groups. Although there was a trend showing very slight increases in thyroid hormone levels from baseline to the 24th, 72nd, and 120th postoperative hours after drug therapy, these changes were not significant, and there were also no significant differences between the groups. There was also no significant statistical difference in CPB time, cross-clamping time, degree of hypothermia, and duration and doses of positive inotropic drugs between groups.</p><p><b>Conclusion:</b> Although thyroid hormone levels were affected by positive inotropic drug usage after open heart surgery, this effect was not significant and thyroid hormone levels remained within normal ranges.</p>


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