Objective To investigate the effect of transversus thoracic muscle plane (TTP) block on stress response and postoperative analgesia in patients undergoing valve replacement under cardiopulmonary bypass (CPB).
Methods Forty patients undergoing elective valve replacement from Sepetmber to November 2019, 29 males and 11 females, aged 35-65 years, BMI 18-25 kg/m2, ASA physical status Ⅱ or Ⅲ and cardiac function Ⅱ or Ⅲ, were randomly divided into two groups: bilateral TTP block combined with general anesthesia group (group A) and single general anesthesia group (group B), 20 patients in each group. Before anesthesia induction, patients in group A underwent bilateral TTP block through parasternal 4 and 5 intercostal spaces under ultrasound guidance, while patients in group B did not undergo treatment. The anesthesia methods were the same in both groups, and patients in both groups received intravenous self-controlled analgesia with sufentanil after surgery. The dosage of sufentanil, remifentanil, dexmedetomidine, and propofol were recorded. Venous blood was drawn before anesthesia, before CPB, at the end of operation, 12 and 24 hours after operation respectively, and plasma concentrations of angiotensin Ⅱ (Ang Ⅱ) and β-endorphin (β-EP) were measured. VAS scores at rest and cough 6, 12, and 24 hours after operation and the number of effective pressing analgesic pumps within the end of operation to 12 hours after operation, 12 to 24 hours after operation were recorded. The duration of mechanical ventilation, ICU stay, pulmonary complications and the incidence of heart failure in the two groups were recorded.
Results The dosages of sufentanil, dexmedetomidine, and propofol in group A were significantly lower than those in group B (P < 0.05). Compared with preanesthesia, the Ang Ⅱ concentration in the two groups increased significantly at the time before CPB, the end of operation, 12 and 24 hours after operation (P < 0.05), the β-EP concentration in the two groups increased significantly at the end of operation, 12 and 24 hours after operation (P < 0.05). The concentration of Ang Ⅱ and β-EP in group A was significantly lower than that in group B at the end of operation, 12 and 24 hours after operation (P < 0.05). The VAS scores at rest and cough 6 and 12 hours after operation, the effective pressing times at the end of operation to 12 hours after operation and the postoperative mechanical ventilation time in group A were significantly lower than those in group B (P < 0.05).
Conclusion Bilateral TTP block can reduce the dosage of anesthetic drugs, reduce stress response, and provide good postoperative analgesia for patients with valve replacement under CPB． |
