Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study
Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study
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DOI：
10.1136/rapm-2018-100178
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发表时间：
2019-05-01
影响因子：
5.1
通讯作者：
Zhou, Jian Ray
中科院分区：
文献类型：
--
作者：
Fujii, Satoru;Roche, Matthew;Zhou, Jian Ray
心脏手术患者在胸骨正中切开术后经常会出现明显的疼痛。胸横肌平面（TTP）阻滞是一种新发展的单次神经阻滞技术，可为前胸壁提供镇痛。在这个双盲试点研究中，我们评估的可行性进行这种新的块作为一种镇痛adjuvant.Methods所有患者年龄在18-90接受择期心脏手术随机分组或标准护理对照组入院后的重症监护室手术。在超声引导下，阻滞组患者接受TTP阻滞，根据体重双侧使用20 mL 0.3%或0.5%罗哌卡因。对照组不接受任何注射。所有区组均由一名麻醉师进行，数据收集由设盲评估员进行。主要可行性结局为招募率、依从性和不良事件。招募率定义为提供知情同意的患者与参与研究的合格患者数量的比率。次要结果包括12小时和24小时的数字评定量表（NRS）疼痛评分，24小时的氢吗啡酮和对乙酰氨基酚的要求，拔管时间，时间到第一次阿片类药物，和患者的满意度（是/否问卷）在24 hours.Results 20例患者接近这项研究，19人参加。每组8例患者接受了预期干预。招募率为95%的所有接触合格的患者，治疗组的依从率为94%。无阻滞相关不良事件。12小时时，阻滞组静息时平均（SD）NRS疼痛评分为3.3（3.2），而对照组为5.6（3.2）。24小时时，阻滞组和对照组的疼痛评分分别为4.1（3.9）和4.1（3.3）。平均（SD）24小时氢吗啡酮给药为1.9（1.1）mg在块组与1.8（0.9）mg在control group.Discussion的TTP块是一种新的疼痛管理策略胸骨切开术后。结果显示，患者招募率、依从性和满意度较高，并提供了一些支持安全性的初步数据。
Introduction Cardiac surgery patients often experience significant pain after median sternotomy. The transversus thoracis muscle plane (TTP) block is a newly developed, single-shot nerve block technique that provides analgesia for the anterior chest wall. In this double-blind pilot study, we assessed the feasibility of performing this novel block as an analgesic adjunct.Methods All patients aged 18-90 undergoing elective cardiac surgery were randomized to the block or standard care control group on admission to the intensive care unit after surgery. Under ultrasound guidance, patients in the block group received the TTP block with 20 mL of either 0.3% or 0.5% ropivacaine bilaterally, based on weight. The control group did not receive any injections. All blocks were performed by a single anesthesiologist, and data collection was performed by blinded assessors. The primary feasibility outcomes were rate of recruitment, adherence, and adverse events. The rate of recruitment was defined as the ratio of patients giving informed consent to the number of eligible patients who were approached to participate. Secondary outcomes included 12-hour and 24-hour Numeric Rating Scale (NRS) pain scores, 24-hour hydromorphone and acetaminophen requirements, time to extubation, time to first opioid administration, and patient satisfaction (on a yes/no questionnaire) at 24 hours.Results Twenty patients were approached for this study and 19 were enrolled. Eight patients received the intended intervention in each group. The recruitment rate was 95% of all approached eligible patients, and the adherence rate to treatment group was 94%. There were no block-related adverse events. The mean (SD) NRS pain scores at rest were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control group at 12 hours. At 24 hours, the pain scores were 4.1 (3.9) vs 4.1 (3.3) in the block and control group, respectively. The mean (SD) 24-hour hydromorphone administration was 1.9 (1.1) mg in the block group vs 1.8 (0.9) mg in the control group.Discussion The TTP block is a novel pain management strategy poststernotomy. The results reveal a high patient recruitment, adherence, and satisfaction rate, and provide some preliminary data supporting safety.