Transversus Thoracis Muscle Plane Block for Postoperative Pain in Adult Cardiac Surgery

Study Overview
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Brief Summary
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Inadequate pain control after coronary artery bypass graft surgery increases mortality and results in a higher incidence of persistent poststernotomy pain syndrome. Our aim is to assess whether ultrasound-guided parasternal intercostal block (PSIB) or surgeon implied transversus thoracic muscle plane block (TTMPB) would improve the postoperative pain scores and decrease tramadol consumption better after coronary artery bypass graft surgery

Official Title
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Bilateral Transversus Thoracis Muscle Plane Block for Acute Postoperative Pain in Adult Coronary Artery Bypass Graft Surgery: A Randomized Controlled Observer Blinded Trial

Conditions
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Postoperative Pain, Chest Pain, Coronary Artery Bypass, Sternotomy

Intervention / Treatment
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* Procedure: Transversus Thoracic Muscle Plane Block
* Procedure: Parasternal Intercostal Plane Block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists physical status II-III Elective coronary artery bypass graft surgery under general anesthesia Exclusion Criteria: American Society of Anesthesiologists physical status IV Emergency surgery and redo surgery Low cardiac output syndrome, perioperative intra-aortic balloon pump support for any reason, bleeding disorder or abnormal coagulation profile, abnormal hepatic and renal parameters, uncontrolled diabetes mellitus, chronic obstructive pulmonary disease, atrial fibrillation on anticoagulation Allergy to any study drugs, local infection at the block site Opioid abuse

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Transversus Thoracic Muscle Plane Block (TTMPB) Group<br>At the TTMPB group, the block will be performed by the surgeon before the closure of the sternum by visualizing the muscles and identifying them. In the TTMPB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between internal intercostal muscle and transversus thoracic muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space. | Procedure: Transversus Thoracic Muscle Plane Block<br>* 40 ml %0.375 bupivacaine divided into 4 equal doses will be injected by the surgeon between internal intercostal muscle and transversus thoracis muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space<br>|
| Active Comparator: Parasternal Intercostal Block (PSIB) Group<br>At the PSIB group, the block will be performed by ultrasound guidance after completion of surgery. PSIB Blocks will be performed under ultrasonography guidance using a linear 6 to 13 megahertz ultrasound probe by the anesthesist.In PSIB group patients will receive 40 ml %0.375 bupivacaine divided into 4 equal doses between psoas major muscle and external intercostal muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space bilaterally. | Procedure: Parasternal Intercostal Plane Block<br>* 40 ml %0.375 bupivacaine injection will be performed by ultrasound guidance after completion of surgery between pectoralis major muscle and external intercostal muscle at the 2nd and 3rd intercostal space and 4th and 5th intercostal space bilaterally by anesthesiologist.<br>|
| No Intervention: Control Group<br>At the control group, no intervention for pain management will be done. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative opioid consumption | Tramadol consumption will be assessed by checking patient daily drug order records | Postoperative 24th hour | 
| Postoperative opioid consumption | Tramadol consumption will be assessed by checking patient daily drug order records | Postoperative 1st, 4th and 12th hour | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Behavioral Pain Scale | A blinded nurse will assess postoperative pain while they are intubated at the 1st and 4th hour by using 3 subscale Behavioral Pain Scale which ranges from 3 (no pain) to 12 (maximum pain) | postoperative 1st and 4th hour | 
| Numeric Rating Scale | A blinded nurse will assess postoperative pain during resting and movement at postoperative 12th and 24th hour by using Numeric rating scale at the extubated patient by using 11-point Numerical Rating Scale which ranges from '0' (means no pain) to '10' (means worst pain imaginable) | Postoperative 12th and 24th hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adult cardiac surgery, poststernotomy pain, transversus thoracic muscle plane block, parasternal intercostal block, behavioral pain scale, numeric rating scale