Transversus Thoracis Muscle Plane Block

Satoru Fujii, Ranjana Bairagi, Matthew Roche, Jian Ray Zhou, Satoru Fujii, Ranjana Bairagi, Matthew Roche, Jian Ray Zhou

Abstract

The transversus thoracis muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. Since its introduction, this technique has been utilized for a wide range of surgical procedures as well as nonsurgical indications. Current evidence suggests that the TTP block provides effective analgesia for breast and cardiac surgeries, cardiac device implantation, pericardiocentesis, and acute and chronic pain management. To date, no major complications have been reported. Currently there is an urgent need to standardize the nomenclature of this technique to facilitate accurate communication amongst care providers, researchers, and authors. In this review, we describe the TTP block technique, review the indications and available evidence in clinical practice, and discuss alternative blocks and future prospects.

Figures

Figure 1
Figure 1
The innervation coverage of the TTP block [11, 20]. The coverage would vary depending on the volume of injectate and the injection site. TTP, transversus thoracis muscle plane.
Figure 2
Figure 2
Patient positioning and ultrasound images in the TTP block. (a) Anterior chest wall of patient after cardiac surgery. The thoracic intercostal spaces are marked. The injection site is indicated by an asterisk. (b) The operator stands beside the patient with ultrasound machine on opposite side. The ultrasound probe is placed longitudinally to the sternum. (c) Ultrasound image after TTP block. The local anesthetic spreads uniformly between the IM and TTM. The pleura is displaced downwards. IM, internal intercostal muscle; TTM, transversus thoracis muscle; LA, local anesthetics.
Figure 3
Figure 3

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