Randomized comparative study of effect of Pecs block and Transversus thoracis muscle plane block on ultra-fast tracking of patients undergoing cardiac surgery

Ultra-fast-tracking (UFT) in cardiac anesthesia refers to minimizing the duration of post-operative ventilatory support and ICU stay and early discharge from hospital. (1-4)  This technique has advantage of reducing the post-operative respiratory complications, improved patient comfort, faster patient mobilization and better resource utilization.(1-3)

Early extubation of patient’s trachea is the core component of UFT. In scientific literature, the definition of ‘early extubation’ for UFT has been used variably ranging from extubation in operating room to within 2-4 hours from end of surgery. (3)

Use of short acting opioids and reduction in dose of opioids is essential for early awakening and extubation of patients. Use of regional anesthesia helps reduce the dose of opioid analgesics in several studies. (6-10). Pectoralis Nerve blocks (Pecs block) and TTP block are regional analgesic techniques suitable for providing analgesia for cardiac surgery.(11-12) Ultrasound guided TTPB has been used by Fujii et al in 20 patients undergoing elective cardiac surgery.(7)  The authors recruited patients of either group aged between 18-90 years to either block group or standard care (no regional anaesthetic block was given). The authors found that the patients receiving block had lower pain scores at rest. There was no block related side effect in any patient. Use of Pecs Block for analgesia in patients for UFT in cardiac anaesthesia was assessed by Kumar et al.(6) Patients aged between 25 and 65 scheduled to undergo cardiac surgery using median sternotomy approach were divided into two groups. One group was given bilateral PEC block while the control group was given only parenteral analgesics for post-operative analgesia. Patients receiving the Pec block had shorter ventilatory support duration, had lower pain scores for first 24 hours, had lower rescue analgesic requirements and had higher inspiratory flow rates as compared to the patients of control group.

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7.      Fujii S, Roche M, Jones PM, et al Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study Regional Anesthesia & Pain Medicine 2019;44:556-60.

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