Randomized Controlled Trial of Ultrasound-Guided Parasternal Intercostal Nerve Block and Transversus Thoracis Muscle Plane Block for Postoperative Analgesia of Cardiac Surgical Patients.

BACKGROUND

Transversus thoracis muscle plane block (TTPB) and parasternal intercostal nerve block (PICNB) inhibit the anterior branches of intercostal nerves and potentially provide adequate analgesia after cardiac surgery. This study aimed to compare these two blocks for a reduction in postoperative opioid consumption after cardiac surgery.

METHODS

This randomized, single-blind trial included 60 adult cardiac surgical patients divided into three groups to receive ultrasound-guided TTPB (group T), PICNB (group P), or no block (group C) before surgery. All patients received standard anesthesia with intravenous etomidate, fentanyl, midazolam, and vecuronium. Postoperative fentanyl consumption in the first 24 hours was the primary outcome variable. Secondary outcomes were pain fentanyl consumption in 48 hours, intensity, analgesia duration, heart rate, mean arterial pressure, and complications.

RESULTS

The groups had similar baseline characteristics. The duration of analgesia was longer, while the intensity of pain and opioid consumption were statistically lower (p<0.01) in groups P and T compared to group C. The differences between groups P and T were not statistically significant. Fentanyl consumption in the first 24 hours was 284.00±37.61 µg, 293.00±35.11 µg, and 383.40±57.21 µg in groups P, T, and C, respectively. Other outcome variables were statistically similar among the groups.

CONCLUSION

Both TTPB and PICNB produce equivalent and satisfactory postoperative analgesia, reducing the postoperative fentanyl use in 24 hours for patients undergoing elective cardiac surgery.