Assessment of a Multimodal Analgesia for Enhanced Recovery After Cardiac Surgery

Assessment of a Multimodal Analgesia for Enhanced Recovery After Cardiac Surgery. A Prospective, Randomized, Study

This work aims to assess the analgesic efficacies of transversus thoracic muscle plane block (TTPB) and transversus thoracic muscle plane block (TTPB) for open cardiac surgeries

In patients undergoing open cardiac operation, pain management is crucial to the improved recovery. Postcardiac surgery pain is significant due to the sternotomy. The sternotomy is commonly cited as the most painful location following cardiac surgery, and postoperative pain is at its worst within the first 24 hours.

The transversus thoracic muscle plane block (TTPB) and the pectointercostal fascial block (PIFB) are new ultrasound (US)-guided regional anesthesia techniques planned to provide analgesia to the anterior thoracic wall. Both blocks primarily target the anterior cutaneous branches of the intercostal nerves (T2-T6), which are responsible for innervating the parasternal and medial anterior chest wall regions.

Inclusion Criteria:

• Age from 40 to 60 years.
• Both sexes.
• American Society of Anesthesiology (ASA) physical status II-III.
• Body mass index (BMI) < 35 kg/m2.
• Underwent cardiac surgery (coronary artery bypass graft surgery with median sternotomy).

Exclusion Criteria:

• Valve replacement procedures.
• Emergency operations.
• Redo surgeries.
• Minimally invasive approaches.
• The presence of psychiatric disorders.
• Cognitive impairment preventing accurate assessment using the verbal numerical rating scale (NRS).
• Known hypersensitivity or a history of allergy to local anesthetics.
• Had severe major organ dysfunction.
• Left ventricular ejection fraction below 30%.
• Pregnancy or breastfeeding.