Effect of Bilateral Transversus Thoracis Muscle Plane Block in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Study Overview
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Brief Summary
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Coronary artery bypass graft surgery is the standard surgical treatment for coronary disease. However, there is no consensus on analgesic management in patients undergoing CABG. The aim of the study is to evualuate efficacy of bilateral transversus thoracis muscle plane (TTMP) block combined with systemic analgesia, compared to systemic analgesia only, in patients undergoing elective on-pump CABG surgery. Our main hypothesis is that a bilateral TTMP block performed after CABG surgery could reduce morphine consumption during the first 48 hours. The investigators conducted an age, gender and type of surgery-matched retrospective cohort study in the Montpellier University Hospital (France).

Official Title
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Effect of Bilateral Transversus Thoracis Muscle Plane Block on Postoperative Morphine Consumption in Patients Undergoing Elective On-pump Coronary Artery Bypass Graft Surgery: a Retrospective Study.

Conditions
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Coronary Artery Disease, Pain Syndrome

Intervention / Treatment
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* Procedure: Ultrasound guided Bilateral Transversus Thoracis Muscle Plane block


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: To be over 18 To be scheduled for CABG surgery in the center of the study during the study period. Exclusion criteria: Chronic pain or opioid use before surgery Recent thoracic regional analgesia (< 1 month) Preoperative dementia or other neurologic or psychiatric disease incompatible with VAS pain scoring. Other technique of regional anesthesia (e.g. thoracic epidural) Opposition to data collection Secondary exlusion criteria: Postoperative prolonged sedation in ICU (> 12 hours) Postoperative surgical complication requiring surgical revision during the first two days. Opposition to data collection expressed secondarily

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Systemic analgesia<br>Patients received only systemic analgesia : Acetaminophen, Ketoprofen, and Nefopam were administered systematically. Morphine was administered if necessary, according to our institutional pain management protocol. | |
| Bilateral TTMP block + systemic analgesia<br>Patients received the same protocol of systemic analgesia associated with a bilateral TTMP block performed during the first four hours after ICU admission, before tracheal tube removal. | Procedure: Ultrasound guided Bilateral Transversus Thoracis Muscle Plane block<br>* In the TTMP block group, an ultrasounded guided TTMP block was performed by an anesthesiologist, in ICU, before tracheal tube removal. Between the 4th et 5th rib, on each side, 40 ml of Ropivacaine 2 mg/ml, in association with Clonidine, was injected single-shot in the tranversus thoracis muscle plane. The targets of local anesthetic were the anterior branches of intercostal nerves from T2 to T6. Dexamethasone 8 mg was injected intravenously.<br>* Other names: Transversus Thoracis Muscle Plane Block. Parasternal Block.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| cumulative morphine consumption | cumulative morphine consumption during the first two days. cumulative morphine consumption on postoperative day 0, 1 and 2, including the morphine administered in intensive care unit, and on postoperative day 1 and 2. | postoperative day 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative pain assessed | Postoperative pain assessed by visual analog scale (VAS) scoring | postoperative day 0, 1 and 2 | 
| Postoperative nausea and vomiting | Postoperative nausea and vomiting | hospital day 7 | 
| Occurrence of prurit | Occurrence of prurit | postoperative day 7 | 
| rate of Delirium | rate of Delirium | postoperative day 7 | 
| rate of Constipation | rate of Constipation | postoperative day 7 | 
| rate of Urinary retention | rate of Urinary retention | until postoperative day 7 | 
| rate of Hypotension | rate of Hypotension | until postoperative day 7 | 
| Pleural drain duration | Pleural drain duration | day 20 | 
| Urinary catheter duration | Urinary catheter duration | day 20 | 
| Duration of hospitalization in ICU | Duration of hospitalization in ICU | day 20 | 
| In-hospital length of stay | In-hospital length of stay | day 20 | 
| Occurrence of atrial fibrillation | Occurrence of atrial fibrillation | until postoperative day 7 | 
| rate of Pneumonia | rate of Pneumonia | until postoperative day 7 | 
| acute kidney injury | acute kidney injury | until postoperative day 7 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cardiac Surgery, Coronary Artery Bypass Graft Surgery, Regional Anesthesia, Transversus Thoracis Muscle Plane Block, Enhanced Recovery After Surgery, Pain, evaluated by visual analog scale score.