The Analgesic Efficacy of Ultrasound-guided Bilateral Transversus Thoracic MusclePlane Block after Open-Heart Surgeries: A Randomized Controlled Study

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).

Ultrasound-Guided Pectoral Nerve Block With Tr Ansverse Thoracic Muscle Plane Block Enhanced World Health Organization on Quality of Life Brief Scale Scores 6 Months After M Odified Radical Mastectomy : A Randomized, Placebo-controlled and Double-Blind Clinical Trial

Background Modified radical mastectomy (MRM) has a large incision range and can cause strong intraoperative stress, a high incidence of postoperative acute pain, and chronic pain. There are few studies on the objective evaluation of the perioperative stress response by some stress-related serological indicators and on the long-term follow-up evaluation of postoperative quality of life and the incidence of chronic pain. This study aimed to evaluate the efficacy of ultrasound guided type Ⅰ Pecs block (Pecs Ⅰ), type Ⅱ Pecs block (Pecs Ⅱ) and transverse thoracic muscle plane block (TTP) on reducing CRP, IL-6, and WBC values during surgery and on enhancing World Health Organization on Quality of Life Brief Scale (QOL) scores 6 months after MRM.Methods The randomized, placebo-controlled and double-blind study was conducted in 76 patients assigned to two groups that received either ultrasound guided Pec Ⅰ + Pec Ⅱ +TTP block with 40 ml of 0.25% ropivacaine (group PT) or saline (group C). The primary outcomes were the changes in CRP, IL-6 and WBC values on the first day before surgery and the first and third days after surgery, the changes in blood glucose levels before and after surgery, and the QOL scores evaluated 6 months after surgery.Results The median (IQR) CRP, IL-6, and WBC values were significantly reduced in group PT on the first day compared with those in group C (12 (10-13.25) mg/l, 10.45 (9.575-11.65) pg/ml, 9 (7.75-9.25)×109/ l, vs 24 (20.75-26.25) mg/l, 25.35 (19.3-29.675) pg/ml, 12 (11-13) ×109/l, respectively, p< 0.001). The median (IQR) QOL was significantly higher in group PT 6 months after surgery than in group C (53(51.75-55) vs 43 (41-51.5), p< 0.001). The incidence of chronic pain was significantly lower, n/all was 4/33 vs 0/34, p< 0.001. Conclusions Ultrasound guided Pecs I, II and TTP block, significantly reduced the CRP, IL-6 and WBC values on the first day; increased the QOL scores and the incidence of chronic pain 6 months after surgery; and promoted the rapid recovery of patients.Trial registration: chictr.org.cn ChiCTR2000033275. Registered on 26 May 2020