Tachy-brady syndrome induced by a transversus thoracis muscle plane block

Han, Qiaoyu; Wang, Lu; Jiang, Luyang; Feng, Yi; Chen, Yu; Chen, Shenglong; Gao, Qing

doi:10.1016/j.jclinane.2021.110327

Cited by 3 publications

(3 citation statements)

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“…[9] TTMPB and PIFB, aiming at the anterior chest wall innervated by branches of intercostal nerves, can achieve the same analgesia for sternotomy in cardiac surgery, [10] but PIFB is more super cial, safe and simple. [11] While the drainage insertion can cause skin incision, rubbing, besides that, irritation of drainage to adjacent tissues and rectus abdominal muscle would result in persistent chest tube pain after surgery which can't be covered by PIFB, [8] so additional methods should be combined for better pain management.…”

Section: Discussionmentioning

confidence: 99%

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Wang

Jiang

et al. 2023

Preprint

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Background: Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, while many patients complained of severe drainage pain which can’t be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods: This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB+RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 hours after surgery. Secondary outcomes included opioid consumption within 48 hours, postoperative pain scores, time to extubation, length of stay in the hospital. Interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-a before and the first 24 hours after surgery were measured. Results: A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 hours after surgery was 2.33±1.77 mg in the PIFB+RSB group vs 3.81±2.24 mg in the PIFB group (p=0.010). Opioid consumption within 48 hours after surgery was also reduced in the PIFB+RSB group (4.71±2.71 mg vs 7.25±3.76 mg, p=0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, the level of IL-6, IL-10 and TNF-a between two groups. Conclusions: The combination of PIFB and RSB reduced postoperative intravenous opioid consumption and prolong the duration of single shot in cardiac surgery. Trial registration: This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.

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Section: Discussionmentioning

confidence: 99%

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Wang

Jiang

et al. 2023

Preprint

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“…Transverse thoracic muscle plane block and PIFB, aiming at the anterior chest wall innervated by branches of intercostal nerves, can achieve the same analgesia for sternotomy in cardiac surgery [ 9 ], but PIFB is more superficial, safer and simpler. [ 10 ] While pain after cardiac surgery is complicated, drainage insertion can cause skin incisions to rub. In addition, irritation of drainage to adjacent tissues and rectus abdominal muscle would result in persistent pain that cannot be covered by PIFB [ 8 ], so additional methods should be combined for better pain management.…”

Section: Discussionmentioning

confidence: 99%

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Wang

Jiang

et al. 2023

BMC Anesthesiol

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Background Pecto-intercostal fascial block (PIFB) provides analgesia for cardiac median sternotomy, but many patients complain of severe drainage pain that cannot be covered by PIFB. Rectus sheath block (RSB) has been attempted to solve this problem, but whether PIFB combined with RSB can achieve better analgesia is uncertain. Methods This was a single-center randomized controlled trial at Peking University People’s Hospital from September 22, 2022 to December 21, 2022. Patients undergoing elective cardiac surgery with a median sternotomy were randomized at a 1:1 ratio to receive either bilateral PIFB and RSB (PIFB + RSB group) or PIFB (PIFB group). The primary outcome was intravenous opioid consumption within 24 h after surgery. Secondary outcomes included opioid consumption within 48 h, postoperative pain scores, time to extubation, and length of stay in the hospital. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α before and the first 24 h after surgery were measured. Results A total of 54 patients were analyzed (27 in each group). Intravenous opioid consumption within 24 h after surgery was 2.33 ± 1.77 mg in the PIFB + RSB group vs 3.81 ± 2.24 mg in the PIFB group (p = 0.010). Opioid consumption within 48 h after surgery was also reduced in the PIFB + RSB group (4.71 ± 2.71 mg vs 7.25 ± 3.76 mg, p = 0.006). There was no significant difference in pain scores, time to extubation, length of stay in hospital, or the levels of IL-6, IL-10 and TNF-α between the two groups. Conclusions The combination of PIFB and RSB reduced postoperative intravenous opioid consumption until 48 h after cardiac surgery. Trial registration This trial is registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR2200062017) on 19/07/2022.

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“…The TTMPB has been shown to be efficacious in cardiac surgery ( 5 , 6 ), but the transverse thoracic muscles are fairly thin and difficult to identify under ultrasound guidance. TTMPB is also prone to stimulate the pleura due to the relatively deep location of transverse thoracic muscles ( 7 ). PIFB is technically less challenging than TTMPB, and has been shown in a previous trial to possess comparable analgesic efficacy to the TTMPB in the area innervated by the anterior branches of the intercostal nerve (Th2-6), and thus useful in cardiac surgery ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of pecto-intercostal fascial block on extubation time in patients undergoing cardiac surgery: A randomized controlled trial

et al. 2023

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ObjectivesEpidural and paravertebral block reduce the extubation time in patients undergoing surgery under general anesthesia but are relatively contraindicated in heparinized patients due to the potential risk of hematoma. The Pecto-intercostal fascial block (PIFB) is an alternative in such patients.MethodsThis is a single-center randomized controlled trial. Patients scheduled for elective open cardiac surgery were randomized at a 1:1 ratio to receive PIFB (30 ml 0.3% ropivacaine plus 2.5 mg dexamethasone on each side) or saline (30 ml normal saline on each side) after induction of general anesthesia. The primary outcome was extubation time after surgery. Secondary outcomes included opioid consumption during surgery, postoperative pain scores, adverse events related to opioids, and length of stay in the hospital.ResultsA total of 50 patients (mean age: 61.8 years; 34 men) were randomized (25 in each group). The surgeries included sole coronary artery bypass grafting in 38 patients, sole valve surgery in three patients, and both procedures in the remaining nine patients. Cardiopulmonary bypass was used in 20 (40%) patients. The time to extubation was 9.4 ± 4.1 h in the PIFB group vs. 12.1 ± 4.6 h in the control group (p = 0.031). Opioid (sufentanil) consumption during surgery was 153.2 ± 48.3 and 199.4 ± 51.7 μg, respectively (p = 0.002). In comparison to the control group, the PIFB group had a lower pain score while coughing (1.45 ± 1.43 vs. 3.00 ± 1.71, p = 0.021) and a similar pain score at rest at 12 h after surgery. The two groups did not differ in the rate of adverse events.ConclusionsPIFB decreased the time to extubation in patients undergoing cardiac surgery.Trial RegistrationThis trial is registered at the Chinese Clinical Trial Registry (ChiCTR2100052743) on November 4, 2021.

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Tachy-brady syndrome induced by a transversus thoracis muscle plane block

Cited by 3 publications

References 10 publications

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

Effect of pecto-intercostal fascial block on extubation time in patients undergoing cardiac surgery: A randomized controlled trial

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