Transverse chest plane block with bilateral catheter insertion for pain control in minimally invasive Pectus excavatum correction surgery

case reports

Abstract

Thoracic surgeries represent a challenge for anesthesiologists in the control of postoperative pain. Post operative pain is responsible for the increase in length of stay, demand for opioids and an important criterion for patient satisfaction. Pectus excavatum (PE) is a deformity of the chest wall characterized by depression of the sternum, the surgical treatment is indicated there are symptoms or limitations of cardiopulmonary function or psychosocial disorder related to aesthetics with influence in the patient's quality of life. Nuss surgery is a minimally invasive technique for PE correction and consists on insertion of a metallic bar posterior to the sternum through the intercostal spaces, this bar propels the sternum correcting the thoracic deformity. The ultrasound-guided transverse thoracic plane block (TTPB) was first described in 2015 and consists of injecting local anesthetic into the space between the transverse thoracic muscle and the internal intercostal muscle, providing anesthesia of the anterior wall of the thorax by blocking the anterior branches intercostal nerves. The present study describes two case reports of young, healthy patients who underwent Nuss surgery for aesthetic reasons for PE correction. In both patients, balanced general anesthesia associated with epidural anesthesia with epidural catheter insertion and bilateral ultrasound-guided TTPB with catheter insertion were performed. Postoperatively, pain control was successfully achieved through the administration of 0.2% or 0.5% ropivacaine according to clinical pain assessment. Thus, there was a reduction in the consumption of opioids and the patients were discharged 72 hours after the operation with safety and satisfaction.