Department of Anaesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Anaesthesiology, Jiangxi Maternal and Child Health Hospital, Nanchang, China.
J Cell Mol Med. 2024 Apr;28(7):e18184. doi: 10.1111/jcmm.18184.
The optimal analgesia regimen after open cardiac surgery is unclear. The aim of this study was to investigate the beneficial effects of continuous transversus thoracis muscle plane (TTMP) blocks initiated before surgery on open cardiac surgery outcomes. A group of 110 patients were randomly allocated to either receive bilateral continuous TTMP blocks (TTP group) or no nerve block (SAL group). The primary endpoint was post-operative pain at 4, 8, 16, 24, 48 and 72 h after extubation at rest and exercise. The secondary outcome measures included analgesia requirements (sufentanil and flurbiprofen axetil administration), time to extubation, incidence of reintubation, length of stay in the ICU, incidence of post-operative nausea and vomiting (PONV), time until return of bowel function, time to mobilization, urinary catheter removal and length of hospital stay. The length of stay in the ICU and length of hospital stay were significantly longer in the SAL group than in the TTP group. NRS scores at rest and exercise were significantly lower in the TTP group than in the SAL group at all time points. The TTP group required significantly less intraoperative and post-operative sufentanil and post-operative dynastat consumption than the SAL group. Time to extubation, time to first flatus, time until mobilization and time until urinary catheter removal were significantly earlier in the TTP group than in the SAL group. The incidence of PONV was significantly lower in the TTP group. Bilateral continuous TTMP blocks provide effective analgesia and accelerate recovery in patients undergoing open heart valve replacement surgery.
开胸心脏手术后的最佳镇痛方案仍不明确。本研究旨在探讨术前开始行连续横突间肌平面（TTMP）阻滞对开胸心脏手术结果的有益影响。将 110 例患者随机分为两组，分别接受双侧连续 TTMP 阻滞（TTP 组）或不接受神经阻滞（SAL 组）。主要终点为拔管后 4、8、16、24、48 和 72 小时休息和运动时的术后疼痛。次要结局指标包括镇痛需求（舒芬太尼和氟比洛芬酯给药）、拔管时间、再插管发生率、ICU 入住时间、术后恶心和呕吐（PONV）发生率、肠功能恢复时间、活动时间、导尿管拔除时间和住院时间。SAL 组 ICU 入住时间和住院时间明显长于 TTP 组。TTP 组在所有时间点的静息和运动时 NRS 评分均明显低于 SAL 组。TTP 组术中及术后舒芬太尼和术后地佐辛用量明显少于 SAL 组。TTP 组拔管时间、首次肛门排气时间、活动时间和导尿管拔除时间明显早于 SAL 组。TTP 组 PONV 发生率明显低于 SAL 组。双侧连续 TTMP 阻滞可为行开胸心脏瓣膜置换术的患者提供有效镇痛并促进恢复。
