• Ibrahim Abdelbaser and Nabil A Mageed.
• Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt. Electronic address: ibraheem2005@mans.edu.eg.
• J. Cardiothorac. Vasc. Anesth. 2022 Aug 1; 36 (8 Pt B): 2870-2875.

ObjectiveUltrasound-guided fascial plane blocks are associated with good postoperative analgesia after pediatric cardiac surgery, with improved safety profile. To the best of the authors' knowledge, this study was the first with the primary aim of assessing the safety profile of transversus thoracis plane (TTP) block in pediatric patients who underwent open cardiac surgery.DesignThis was a retrospective cohort study.SettingUniversity hospital.ParticipantsThe authors reviewed the medical records of patients aged 6 months to 18 years who underwent open cardiac surgery via median sternotomy incision and who received bilateral transversus thoracis muscle plane block from January 2019 to August 2021 in their institutional hospital.InterventionsPatients received ultrasound-guided bilateral TTP block.Measurements And Main ResultsThe primary outcome measure was the incidence of mechanical complications (subcutaneous hematoma, internal mammary vessels injury, pleural puncture, pneumothorax, pericardial puncture, injury of the heart, and hemopericardium). The secondary outcomes were the incidences of hypoxia, hypotension, and bradycardia after local anesthetic injection, allergy to local anesthetic, local infection, and postoperative neuropathic pain at the sternal area. A total of 236 patients who received bilateral TTP block were screened for eligibility, of whom 38 patients were excluded. Left-sided pleural and pericardial puncture occurred in 1 patient (0.5%) without clinical evidence of pneumothorax, hemopericardium, or traumatic cardiac injury as directly seen after sternotomy. One patient (0.5%) developed a self-limiting small subcutaneous hematoma. Pneumothorax, injury of internal mammary vessels, cardiac injury, and hemopericardium were not observed in any patient. No patient developed an allergy to local anesthetic, hypoxia, bradycardia, or hypotension after local anesthetic injection. Poststernotomy neuropathic pain was not recorded in any patient.ConclusionThe above complications were noted in patients who received TTP block, and further prospective studies with more patients are required to comment on its safety.Copyright © 2021 Elsevier Inc. All rights reserved.

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