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Mohamed Ahmed Hamed, Maged Labib Boules, Mina Mahrous Sobhy, Mahdy Ahmed Abdelhady Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, EgyptCorrespondence: Mohamed Ahmed Hamed, Department of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum, 63511, Egypt, Tel +20 111-856-0065, Email mah07@fayoum.edu.egBackground: We aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral transversus thoracic muscle plane block after open-heart surgeries.Methods: Seventy patients aged above 18 years and scheduled for valve replacement or adult congenital via median sternotomy were enrolled in this study. Patients were divided into two groups, randomized by computer-generated random numbers: the block group, which had the ultrasound-guided bilateral transversus thoracic muscle plane block, and the control group, which had a sham block. The primary outcome was total fentanyl consumption in the first 24-hours. The secondary outcomes were pain score, time to the first analgesic request, time to extubation, ICU stays, and hospital stay.Results: The total fentanyl consumption in the first 24 hours was significantly lower in the block group, with a mean difference of − 158.286 (95% CI = (− 179.271 to − 137.300; p =< 0.0001)). The time to the first analgesic request was statistically significantly shorter in the non-block group (median 3 hours) than the block group (median 14 hours). During the postoperative period (0.5– 24 hours), at-rest pain scores were 1.86 units lower in the block group (the estimate was − 1.80, 95% CI = − 2.14 to − 1.45, t = − 10.323 with p < 0.0001). Likewise, pain scores with cough were 3.29 units lower in the block group (the estimate was − 3.29, 95% CI = − 3.80 to − 2.77, t = − 12.703, p < 0.0001).Conclusion: Bilateral transversus thoracic muscle plane block is a promising and effective technique in reducing opioid consumption and controlling post-sternotomy pain after open-heart surgery via median sternotomy.Keywords: transversus thoracic muscle plane block, fentanyl consumption, sternotomy, postoperative pain

Maged Labib Boules, Abeer Shaban Goda, Mahdy Ahmed Abdelhady, Shimaa Adel Abu El-Nour Abd El-Azeem, Mohamed Ahmed Hamed Department of Anesthesiology, Faculty of Medicine, Fayoum University, Cairo, EgyptCorrespondence: Mohamed Ahmed HamedDepartment of Anesthesiology, Faculty of Medicine, Fayoum University, Fayoum 63511, EgyptTel +2011 18 560 065Email mah07@fayoum.edu.egBackground: This study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery.Methods: Sixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction.Results: The median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p< 0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]).Conclusion: Compared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.Keywords: erector spinae plane block, transversus abdominis plane block, cesarean, analgesia, tramadol