Application of bilateral transverse thoracic muscle plane block (modified approach) combined with general anesthesia in off-pump coronary artery bypass grafting / 解放军医学杂志

ABSTRACT

Objective To investigate the safety and effectiveness of bilateral transverse thoracic muscle plane (TTP) block (modified approach) combined with general anesthesia in off-pump coronary artery bypass grafting (OPCABG). Methods The clinical data of 60 patients undergoing OPCABG, selected from March to August 2019 in General Hospital of Northern Theater Command, were retrospectively analyzed and divided into TTP block with general anesthesia group (TTP+general anesthesia group, n=30) and general anesthesia group (n=30) according to anesthesia mode. Patients in TTP+general anesthesia group undergone bilateral TTP block (modified approach, 0.25% ropivacaine 20 ml each side) before anesthesia induction, and both groups were induced by routine anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded and analyzed before and after cutting, splitting and closing the sternum, and the total dosage of sufentanil at the end of operation was recorded. The levels of lactic acid and blood glucose in blood gas analysis of patients at the time they entered the room, the operation ended and at 2, 4, 6, 8, 10, 12, 16, 20 and 24 h after the operation were recorded. The visual analogue scale (VAS) scores in resting and moving state at 12, 24 and 48 h after operation were recorded. The numbers of patients who were first added analgesic drugs (pethidine) on the day, the first day and the second day after operations were recorded, and the occurrence of postoperative adverse reactions was recorded. Results Compared with general anesthesia group, the change rate of MAP and HR in TTP+general anesthesia group decreased slightly at each time point, but the difference was not statistically significant (P>0.05). The differences of lactic acid at 2 and 4 h after operation were statistically significant (P0.05); while the dosage of sufentanil in TTP+general anesthesia group was obviously decreased, and the number of patients who were added analgesics at the postoperative day was markedly reduced, both were with statistical significance (P0.05). The incidence of postoperative chills was obviously lower in TTP+general anesthesia group than in general anesthesia group with a statistical difference (P<0.05). Conclusion Bilateral TTP block (modified approach) combined with general anesthesia can provide good perioperative analgesia for patient undergoing OPCABG, reduce the use of opioids, and inhibit the stress response to a certain extent, thus having better safety and effectiveness.