Incorporation of the Transverse Thoracic Plane Block Into a Multimodal Early Extubation Protocol for Cardiac Surgical...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Pain Management

Background:

• Early extubation is a key goal for cardiac surgery patients.
• Multimodal pain management strategies are crucial for optimizing recovery.
• Transverse thoracic plane (TTP) block is an emerging technique for thoracic analgesia.

Purpose of the Study:

• To evaluate the impact of TTP block combined with multimodal analgesia on extubation time, opioid consumption, and length of stay in cardiac surgery patients undergoing median sternotomy.
• To assess the safety and feasibility of TTP block in this patient population.

Main Methods:

• Retrospective analysis of 75 patients per group (TTP block vs. control) undergoing cardiac surgery via median sternotomy.
• TTP block involved bilateral ultrasound-guided injection of 0.5% bupivacaine + epinephrine prior to incision.
• Multimodal pain management included intravenous analgesics and the TTP block.

Main Results:

• 50.6% of patients in the TTP block group were extubated in the operating room compared to 8.6% in the control group.
• Intraoperative opioid consumption was reduced, and intensive care unit (ICU) and total length of stay decreased by 5 hours and 1 day, respectively.
• No significant difference in postoperative opioid consumption or reported complications directly attributed to the block.

Conclusions:

• TTP block combined with a multimodal regimen facilitates early extubation in cardiac surgery patients without increasing re-intubation rates.
• The TTP block is a safe and effective procedural adjunct for pain management in patients undergoing median sternotomy.
• This approach offers potential benefits for patient recovery and resource utilization.