Optimized strategy of anesthesia in off-pump coronary artery bypass grafting: transversus thoracic muscle plane block combined with general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the improved efficacy of transversus thoracic muscle plane (TTP) block combined with general anesthesia for off-pump coronary artery bypass grafting (OP-CABG).Methods:Sixty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes, aged 55-63 yr, weighing 65-81 kg, scheduled for elective OP-CABG, were divided into 2 groups ( n=30 each) using a random number table method: TTP block combined with general anesthesia group (group TG) and general anesthesia group (group G). Midazolam-propofol-sufentanil-rocuronium was used to induce anesthesia, and sevoflurane-remifentanil-propofol was used to maintain anesthesia.In group TG, ultrasound-guided TTP block was performed at 20 min before anesthesia induction, and 0.375% ropivacaine plus 0.5% lidocaine 20 ml was injected between bilateral intercostal and transverse pectoral muscles.Both groups received patient-controlled intravenous analgesia with sufentanil, oxycodone 0.05 mg/kg was intravenously injected as rescue analgesic, and the postoperative visual analogue scale scores were maintained≤ 4 points.The intraoperative consumption of remifentanil and propofol, consumption of sufentanil within 24 h after operation, and requirement for rescue analgesia were recorded.The postoperative length of stay in intensive care unit, time to first flatus, length of hospitalization, postoperative nausea/vomiting, lung inflammation, pruritus and nerve block-related complications were recorded. Results:Compared with group G, the consumption of intraoperative remifentanil and postoperative sufentanil after operation were significantly reduced, the requirement for postoperative rescue analgesia was decreased, the postanesthesia care unit stay time, length of hospitalization and time to first flatus were shortened, and the incidence of postoperative nausea/vomiting and lung inflammation was decreased in group TG ( P<0.05). No pruritus and nerve block-related complications were found in the two groups. Conclusion:Ultrasound-guided TTP block combined with general anesthesia can provide good perioperative analgesia for the patients undergoing OP-CABG and reduce the amount of opioids used, which is helpful in improving the prognosis.