Comparative Analysis of Ultrasound-Guided Pain Management Approaches for Sternotomy in Cardiac Surgeries-Transversus Thoracic Muscle Plane Block vs Pecto-Intercostal Fascial Block.

Abstract

Background: Pain management after sternotomy in cardiac surgery is vital for recovery. Opioids are commonly used, but they carry risk. Central neuraxial techniques and nerve blocks are options for a multimodality approach. Fascial plane blocks such as the transversus thoracic muscle plane block (TTMPB) and the pecto-intercostal fascial block (PIFB) are a relatively new way to relieve pain, and their popularity has increased with the use of ultrasound for precise anatomic visualization. Because the effectiveness of both blocks is similar, we conducted this study to compare the pain management of the TTMPB and the PIFB after sternotomy in cardiac surgery.

Methods: This randomized double-blind study included 118 patients who underwent cardiac surgery. In the TTMPB group (n=59), 20 mL of 0.2% ropivacaine was injected bilaterally using ultrasound assistance in the transversus thoracic plane. In the PIFB group (n=59), 20 mL of 0.2% ropivacaine was injected in the pecto-intercostal plane. Study outcomes were opioid consumption in the first 24 hours and pain scores at 0, 3, 6, 12, and 24 hours postoperatively.

Results: Patient characteristics in the 2 groups were similar. Opioid consumption was similar in both groups (P=0.672), and we found no difference in pain scores between the 2 groups at any of the time intervals.

Conclusion: The TTMPB and the PIFB were similarly effective in treating acute poststernotomy pain in our patient population.