Transverse Thoracic Plane Block, Midpoint Transverse Process Plane to Pleura Block and Erector Spinae Plane Block for Analgesia in Patients Undergoing Thoracoscopic Sympathectomy

A Randomized Clinical Trial Comparing Transverse Thoracic Plane Block, Midpoint Transverse Process Plane to Pleura Block and Erector Spinae Plane Block for Analgesia in Patients Undergoing Thoracoscopic Sympathectomy

This study compares the transversus thoracic muscle plane block (TTPB), midtransverse to pleura block (MTPB), and erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing thoracoscopic sympathectomy.

Thoracoscopic sympathectomy is a well-established procedure for the treatment of various hyperhidrosis disorders and certain vascular conditions, involving the division of sympathetic nerve fibers in the thoracic cavity.

The erector spinae plane block (ESPB) is an interfascial regional anesthesia block for thoracic analgesia which can be performed by superficial or deep needle approach.

The mid-transverse to pleura block (MTPB) was first described as a modified paravertebral block.

Transversus thoracic muscle plane block (TTPB) is a newly developed technique in which LA is injected into the fascial plane between the transversus thoracic muscle and the internal intercostal muscles for blocking the anterior cutaneous branches of intercostal nerves from thoracic (Th) 2 to Th 6.

Inclusion Criteria:

• Age from 18 to 65 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status I-II.
• Scheduled for thoracoscopic sympathectomy

Exclusion Criteria:

• Coagulopathy.
• History of opiate abuse.
• Pre-existing chronic pain.
• Allergy to local anesthetics or analgesics.
• Infection at the site of injection.
• Mental or neurological disorders.
• Pregnancy