Kaye Alan D, Sampognaro Carliss M, Shah Shivam S, Duplechin Drake P, Curry Grant C, Rodriguez Victoria A, Ahmadzadeh Shahab, Mathew Jibin, Palowsky Zachary R, Shekoohi Sahar
Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA.
Curr Pain Headache Rep. 2025 Jan 4;29(1):8. doi: 10.1007/s11916-024-01357-w.
Effective pain management in cardiac surgery presents as a continuous challenge related to the intensity of postoperative pain and reliance on opioid therapy. The dependance of opioid-based therapies is concerning, as these therapies carry risk future addiction and potential severe side effects. The transversus thoracic plane block (TTPB) has emerged as a promising regional anesthesia technique that blocks the anterior branches of the intercostal nerves in the chest wall, potentially providing improved analgesia for cardiac surgery patients. The present investigation evaluates the efficacy of TTPB in reducing opioid consumption, decreasing postoperative pain scores, and enhancing recovery outcomes in patients undergoing cardiac surgeries.
Data from randomized controlled trials revealed that TTPB significantly reduced 24-hour opioid consumption, increased the time to first rescue analgesic, and lowered Visual Analog Scale (VAS) pain scores both at rest and with movement, particularly in the first 12 h post-surgery. Additional benefits include fewer opioid-related side effects, such as nausea and pruritus, and reductions in intensive care unit (ICU) length of stay. Studies also suggested that TTPB can support earlier extubation and accelerated recovery, contributing to higher patient satisfaction and overall improved postoperative outcomes.
Despite these promising results, challenges in technique standardization and limited long-term data are still obstacles that prevent widespread adoption. Achieving consistent TTPB efficacy requires technical precision in ultrasound guidance, and there is little research on its effectiveness across diverse populations, such as pediatric and high-risk cardiac patients. Addressing these gaps through multi-center, long-term studies could help establish TTPB as a prominent pain management strategy in cardiac surgery to minimize opioid dependence and enhance patient comfort and recovery.
心脏手术中的有效疼痛管理一直是一项持续的挑战，这与术后疼痛的强度以及对阿片类药物治疗的依赖有关。基于阿片类药物的治疗存在依赖性，因为这些治疗存在未来成瘾的风险以及潜在的严重副作用。胸横肌平面阻滞（TTPB）已成为一种有前景的区域麻醉技术，它可阻滞胸壁肋间神经的前支，有可能为心脏手术患者提供更好的镇痛效果。本研究评估了TTPB在减少心脏手术患者阿片类药物用量、降低术后疼痛评分以及改善恢复结果方面的疗效。
随机对照试验的数据显示，TTPB显著减少了24小时阿片类药物用量，延长了首次使用解救镇痛药的时间，并降低了静息和活动时的视觉模拟评分（VAS）疼痛评分，尤其是在术后的前12小时。其他益处包括减少与阿片类药物相关的副作用，如恶心和瘙痒，并缩短重症监护病房（ICU）住院时间。研究还表明，TTPB有助于更早拔管和加速恢复，从而提高患者满意度并总体改善术后结果。
尽管取得了这些令人鼓舞的结果，但技术标准化方面的挑战和长期数据有限仍然是阻碍该技术广泛应用的障碍。要实现一致的TTPB疗效，需要在超声引导下具备技术精准度，而且对于其在不同人群（如儿科和高危心脏患者）中的有效性研究较少。通过多中心、长期研究来填补这些空白，可能有助于将TTPB确立为心脏手术中一种重要的疼痛管理策略，以尽量减少对阿片类药物的依赖，并提高患者舒适度和促进恢复。
