Postoperative pain following open-heart surgery is primarily caused by median sternotomy,although additional contributors include costovertebral joint stress related to sternalretraction and the presence of chest wall and mediastinal drains during the postoperativeperiod. This pain is often severe, especially in the early postoperative hours, makingeffective management both challenging and essential. Insufficient pain control frequentlynecessitates high doses of opioids, which may lead to adverse effects such as nausea,vomiting, respiratory complications, and postoperative delirium. Excessive use ofanesthetic agents or opioids can also delay extubation and prolong the process of weaningfrom mechanical ventilation.The modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) isa regional anesthesia technique performed beneath the costal margin between the internaloblique and transversus abdominis muscles. It provides broad dermatomal coverage,extending approximately from the upper thoracic to the lower thoracic and upper lumbarsegments. This study aims to evaluate the postoperative analgesic effectiveness ofcombining the M-TAPA block with a parasternal block in patients undergoing open-heartsurgery.
Postoperative pain following open-heart surgery is primarily caused by median sternotomy,
although additional contributors include costovertebral joint stress related to sternal
retraction and the presence of chest wall and mediastinal drains during the postoperative
period. This pain is often severe, especially in the early postoperative hours, making
effective management both challenging and essential. Insufficient pain control frequently
necessitates high doses of opioids, which may lead to adverse effects such as nausea,
vomiting, respiratory complications, and postoperative delirium. Excessive use of
anesthetic agents or opioids can also delay extubation and prolong the process of weaning
from mechanical ventilation.
The modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is
a regional anesthesia technique performed beneath the costal margin between the internal
oblique and transversus abdominis muscles. It provides broad dermatomal coverage,
extending approximately from the upper thoracic to the lower thoracic and upper lumbar
segments. This study aims to evaluate the postoperative analgesic effectiveness of
combining the M-TAPA block with a parasternal block in patients undergoing open-heart
surgery.
Other: M TAPA block
In the M-TAPA group, the block will be performed preoperatively with the patient in the
supine position under ultrasound guidance using a high-frequency linear probe (GE
ML6-15-D Matrix Linear, Boston, USA) and an 80-mm block needle (Stimuplex Ultra®, Braun,
Melsungen, Germany). After identifying the appropriate plane between the transversus
abdominis muscle and the lower surface of the costal cartilage, 5 mL of saline will be
injected to confirm correct placement. Subsequently, 20 mL of 0.25% bupivacaine will be
injected bilaterally (a total of 40 mL for both sides).
Other: Parasternal blocks
Before intubation, the block will be performed under aseptic conditions using a
high-frequency ultrasound probe (GE ML6-15-D Matrix Linear, Boston, USA) placed
immediately lateral to the sternum after identifying the second to fourth intercostal
spaces. An 80-mm echogenic block needle (Stimuplex Ultra®, Braun, Melsungen, Germany)
will then be advanced using an in-plane approach from the skin toward the plane between
the pectoralis major and intercostal muscles. A total of 10 mL of 0.25% bupivacaine will
be injected bilaterally.
Other: Local infiltration
Local anesthetic infiltration (10 mL of 0.25% bupivacaine) will be administered around
the chest tube and mediastinal drain sites.
Inclusion Criteria:
- Patients aged 18 to 85 years with ASA physical status II-III who are scheduled to
undergo elective open-heart surgery will be included.
Exclusion Criteria:
Patients who refuse to participate in the study
Patients with coagulopathy
Patients with a history of allergy or toxicity to local anesthetics
Patients with hepatic or renal failure
Patients with uncontrolled diabetes mellitus
Patients with uncontrolled hypertension
Mentally disabled patients
Patients receiving chronic pain therapy (opioid use)
Patients using antidepressant medications
Patients with neuropathic pain
Patients with infection at the injection site
Pregnant, suspected pregnant, or breastfeeding women
Not Provided
Eralp Çevikkalp
+905054554875
eralpcevikkalp@hotmail.com
Emre ULUSOY
+905379492799
emreulusoy36@gmail.com
Not Provided