Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study

Study objective: Adequate perioperative pain control in children undergoing cardiac surgery is mandatory. Intravenous opioids and neuraxial anesthetic techniques have been used but didn't gained any popularity. The aim of the current study was to evaluate the analgesic efficacy of transversus thoracis plane (TTP) block in pediatric cardiac surgery. Design: Superiority, randomized, double-blind, controlled study. Setting: Intraoperative and postoperative in intensive care unit (ICU), Mansoura university children hospital, Egypt. Patients: Eighty pediatric patients aged 2-12 years, undergoing cardiac surgery via median sternotomy, were randomly allocated into 2 equal groups, the control group and TTP block group. Interventions: Controlled group received only fentanyl for perioperative analgesia, while TTP block was performed in the intervention group (TTP group). Measurements: The primary outcome measure was the total dose of fentanyl in the first postoperative 24 h after extubation, while the secondary outcome measures were postoperative pain score, intraoperative fentanyl consumption, time to extubation and ICU length of stay. Main results: During the first postoperative 24 h, total fentanyl consumption was significantly lower (P < 0.05) in the TTP block group (9.892 3.397 mu g/kg) than the control group (18.500 +/- 3.401 mu g/kg) and modified objective pain score was significantly (P < 0.05) lower in TTP block group than the control group all over the time. Total intraoperative fentanyl requirement was significantly (P < 0.05) lower in TTP block group (8.27 +/- 1.170 mu g/kg) than the control group (13.72 +/- 1.186 mu g/kg). Conclusion: The use of TTP block decreased perioperative fentanyl consumption and reduced postoperative pain intensity.