Effect Of Transversus Thoracis Muscle Plane Block On Enhanced Recovery After Surgery In Valve Replacement Of Patients Of Mitral Stenosis

Objective:To evaluate the effect of transversus thoracis muscle plane block on enhanced recovery after surgery in valve replacement of patients of mitral stenosisMethods:Sixty patients with mitral valve replacement who underwent cardiopulmonary bypass surgery were selected and randomly divided into two groups: Group A was a simple general anesthesia group + PCIA analgesia,and group B was bilateral TTMP block + general anesthesia + PCIA analgesia group,After intubation of general anesthesia in group B,ultrasound-guided bilateral TTMP block was performed.Patients in groups A and B were connected to intravenous PCIA 30 minutes before the end of surgery for self-controlled analgesia.The formula was: Sufentanil 100 ug +Flurbiprofen 100 mg + Ondansetron 24 mg was diluted to 100 ml,set 0.5ml / h,controlled 3ml / time,and the lock time was 20 min.Recording heart rate and blood pressure when entering the operating room(T1),after tracheal intubation(T2),when cutting the skin(T3),when sawing the sternum(T4),when entering the intensive care unit(T5),when removing the tracheal tube(T6),leaving the Intensive Care Unit(T7).Recording the total amount of sufentanil in the two groups of patients in the operation.Recording the VAS scores of patients immediately after extubation,2 hours,6 hours,24 hours and 48 hours after extubation.Accurately recording the patient's intraoperative time,length of incision,intraoperative blood loss,infusion volume,postoperative amount of sufentanil,and the number of PCIA self-controlled administration within 48 hours after operation.Recording the incidence of postoperative nausea and vomitting(PONV),extubation time,intensive care unit residence time,postoperative drainage tube indwelling time,postoperative recovery of exhaustion and defecation time,time to get out of bed and patients were recorded Hospitalization time.Record whether the patient is intubated again and transferred to the intensive care unit again after operation.Results:There were no significant differences in the operation time,the length of the incision,the intraoperative blood loss,and the infusion volume of the patients between groups A and B(P> 0.05).The amount of sufentanil used in group B was significantly less than that group A(P <0.05).The incidence of postoperative PONV in group B was significantly lower than that in group A(P <0.05).The time of mechanical ventilation,the time of stay in the intensive care unit,the time of postoperative exhaustion and defecation,the time of drainage tube retention,and the time of getting out of bed in group B were significantly shorter than in group A(P<0.05).However,there were no significant differences in discharge time between groups A and B(P> 0.05).Regarding the perioperative circulatory system,compared with the T2 time point,there were no significant differences in the average arterial pressure and heart rate at the T3 and T4 time points in Group B(P> 0.05).At time points T3,T4 and T6,the average arterial pressure and heart rate in group B were significantly lower than those in group A(P <0.05).At time T7,there were no significant differences in average arterial pressure and heart rate between groups A and B(P> 0.05).In terms of VAS score,in the time of immediately after extubation,2hours,6 hours,and 24 hours after extubation,the score of group B was significantly lower than that of group A(P <0.05),and there were no significant differences between groups A and B at 48 hours after extubation(P> 0.05).The number of times of PCIA self-controlled compressions in group B was significantly lower than group A(P <0.05).There were no significant differences between groups A and B in reintubation and transfer to the intensive care unit(P> 0.05).Conclusion:General anesthesia combined with TTMP block can provide good perioperative analgesia and accelerate the postoperative recovery for cardiac patients undergoing mitral valve replacement.