Ultrasound-guided mid-point transverse process to pleura block versus thoracic paravertebral block in pediatric open-heart surgery: A randomized controlled non-inferiority study
Authors' conclusion
MTPB is non-inferior to TPVB in attenuating the intraoperative hemodynamic stress response to noxious surgical stimuli and in reducing perioperative opioid consumption, extubation time, and ICU discharge time. Moreover, MTPB is technically easier than TPVB and requires less time to perform.
Study context
- Population
- Children aged 2–12 years, American Society of Anesthesiologists (ASA) II, scheduled for elective open cardiac surgery with midline sternotomy for repair of simple noncyanotic congenital heart defectsrecruited
- Participants
- 83 children
- Comparison
- MTPB vs thoracic paravertebral block (TPVB)
- Primary endpoint
- Hemodynamic responses to sternotomy incision (HR and invasive MAP), recorded before and after induction, after skin incision, after sternotomy, 15 min after cardiopulmonary bypass (CPB) and after sternal closure
Methodological detailssingle-centre, double-blind, non-inferiority
- Single-centre
- Double-blind
- Non-inferiority
Primary result
As reported in the abstract
- No significant differences in HR and mean arterial pressure (MAP) between TPVB and MTPB at any time point
Secondary outcomes
Time to perform bilateral block · significantly shorter with MTPB
P < 0.001
Fentanyl consumption, first 24 h after extubation
Extubation time
ICU discharge time
| Outcome | TPVB | MTPB |
|---|---|---|
| Intraoperative fentanyl consumption | 4 (IQR 2–4) | 4 (IQR 2–4) |
Intraoperative fentanyl consumption
- Similar in the TPVB and MTPB groups
Fentanyl consumption, first 24 h after extubation
- Similar in the TPVB and MTPB groups
Extubation time
- Comparable in the TPVB and MTPB groups
Intensive care unit (ICU) discharge time
- Comparable in the TPVB and MTPB groups
Modified objective pain score (MOPS) pain scores at 1, 2, 6, 12, 18 and 24 h after extubation
- Similar in both groups
Safety
Non-surgical complications (pruritus, vomiting, pneumothorax, hematoma, local anesthetic toxicity)
- Incidence similar in both groups
Original publication
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