Transversus thoracic muscle plane (TTP) block, first reported as a peripheral nerve block in 2015, supports pain relief along with pectoralis nerve (PECS) II block. TTP block targets the anterior branches of the intercostal nerves (T2–6).1,2 The effectiveness of bilateral TTP block for perioperative pain management in cardiac surgery has recently been reported.3 Here, I describe my technique for bilateral TTP blocks in cardiac surgery.
The TTP block was performed in a supine position under general anesthesia. First, a high linear probe of the ultrasound system was attached at sagittal plane to the sternum and counted from T2 near the clavicle to T5. Then the linear probe was rotated by 90° and attached between the forth and the fifth costal cartilages connecting at the sternum near nipple (Video 1). Then, the transversus thoracic muscle and the internal intercostal muscle were identified. A total of 30 mL of 0.25% levobupivacaine was injected bilaterally into the interfascial plane (15 mL into each side), between the transversus thoracic muscle and the internal intercostal muscle between the fourth and fifth costal cartilages connecting at the sternum. Pleural downward displacement could be used as an ultrasound endpoint. After the injection, the spread of local anesthetic was confirmed by using the probe (Video 2).
By performing the TTP blocks, the cumulative amount of fentanyl used during the perioperative period can be decreased, leading to earlier patient recovery.
Ueshima H, Kitamura A.
Blocking of multiple anterior branches of intercostal nerves (Th2–6) using a transversus thoracic muscle plane block.
Reg Anesth Pain Med 2015;40:388.
Ueshima H, Otake H.
Addition of transversus thoracic muscle plane block to pectoral nerves block provides more effective perioperative pain relief than pectoral nerves block alone for breast cancer surgery.
Br J Anaesth 2017;118:439–443.
Ueshima H, Otake H.
Continuous transversus thoracic muscle plane block is eective for the median sternotomy.
J Clin Anesth 2017;37:174.