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Trunk Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Rowan Sherwood
Transversus thoracis is located on the inner surface of the anterior thoracic wall (Standring 2016). It originates from the sternum, xiphoid process, and the sternal ends of the costal cartilages of ribs four through seven (Standring 2016). The muscle fibers separate into slips that typically attach to the costal cartilages of ribs two through six (Standring 2016).
Mechanics of the Chest Wall Muscles
Published in Alan D. Miller, Armand L. Bianchi, Beverly P. Bishop, Neural Control of the Respiratory Muscles, 2019
Although it has long been neglected, the triangularis sterni or transversus thoracis muscle has an important respiratory function in quadrupeds. In the dog and in the cat, it is invariably active and shortens during the expiratory phase of the breathing cycle.19 In so doing, it pulls the ribs caudally and deflates the rib cage below its resting position. When the muscle relaxes at end-expiration, there is therefore a passive cranial displacement of the ribs and an increase in rib cage volume that precedes the onset of the inspiratory muscle contraction. The triangularis sterni in these animals thus shares the work of breathing with the inspiratory muscles and helps the parasternal intercostals produce the rhythmic inspiratory expansion of the rib cage.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The muscles of the thorax itself are the internal and external intercostals, subcostals, transverse thoracis, levatores costarum, inferior and superior serratus posterior, and the diaphragm. The 11 intercostal muscles lie between the ribs and draw adjacent ribs together. When the first rib is braced by the scalene muscles that run between it and the cervical vertebrae, the external intercostals increase the volume of the thoracic cavity by raising the ribs on contraction. Conversely, when the last rib is braced by the quadratus lumborum muscle in the lumbar region, the internal intercostals decrease the volume of the thoracic cavity. Similarly, the action of transversus thoracis is to draw the anterior part of the ribs distally and decrease the volume of the thoracic cavity. The levatores costarum and superior serratus posterior raise the ribs and increase the thoracic volume. The inferior serratus posterior draws the distal ribs outwards and downwards, counteracting the inward pull of the diaphragm.
The effect of combined ultrasound-guided transverse thoracic muscle plane block and rectus sheath plane block on the peri-operative consumption of opioids in open heart surgeries with median sternotomy
Published in Egyptian Journal of Anaesthesia, 2023
Fady Medhat Mokhtar Nessim, Alaa Eid Mohamed Hassan, Fahmy Saad Latif Eskander, Riham Fathy Galal Nady
In contrast to what M. E. Aydin and his colleagues concluded in their study, our findings in the current study revealed that although the block group’s postoperative opioid consumption was lower than that of the saline group’s even though we used the same Aydin’s technique, there was no significant difference between them (table 5). Additionally, the median postoperative VAS scores were nearly identical in both groups, with a p-value of (0.8) (table 6). The relative short duration of action of bupivacaine to cover the entirety of the procedure may be the cause of this. The unequal distribution of the LA in the targeted block plane and the surgical dissection in the same plane during the internal thoracic artery harvesting are further potential causes of the TTP block’s limited postoperative analgesic impact. Previous surgery in the TTP plane can further reduce the effectiveness of the TTP block. The spread of local anaesthetic following TTP block in a patient who had previously undergone internal thoracic artery harvest was examined in a cadaver study by Fujii et al. The transversus thoracis plane experienced nonuniform local anaesthetic dissemination due to tissue displacement and scar remodelling during surgery, which could have resulted in a poor or ineffective block [15].
How to minimize peri-procedural complications during subcutaneous defibrillator implant?
Published in Expert Review of Cardiovascular Therapy, 2020
Muhammad R. Afzal, Toshimasa Okabe, Kevin Hsu, Schuyler Cook, Tanner Koppert, Raul Weiss
Adjunctive regional anesthesia using serratus anterior plain block and transversus thoracis muscle plane block have been shown to be safe and feasible during implantation of S-ICD [33,34]. Serratus plane block is performed under ultrasound guidance by placing the ultrasound at mid axillary line and moving medially to identify latissimus dorsi and serratus anterior muscle. The anesthetic medication is deposited in the latissimus dorsi and serratus anterior muscle plane. For the transversus thoracis muscle plane block, the ultrasound is placed on the left parasternal border at T3–T4 level and moved medially until the plane between the internal intercostal and transversus thoracis muscle is identified. The anesthetic medication is deposited between the internal intercostal and transversus thoracis muscle. Anesthesiology team typically performs these blocks. The studies have shown some subjective improvement in the requirement of pain medications in the postoperative period; although, there was no objective measurement for this. Further studies are needed to explore the role of adjunctive regional anesthesia. One limitation of this technique is the requirement of an anesthesiologist for pain block [35]. This may not be feasible from logistics standpoint and may incur additional financial burden.
Efficacy of bilateral PECS II block in postoperative analgesia for ultrafast track pediatric cardiac anesthesia
Published in Egyptian Journal of Anaesthesia, 2022
Farouk Kamal, Ahmed Abd El-Rahman, Rasha Mahmoud Hassan, Amr Fouad Helmy
Zhang et al. conducted an RCT on a group of 100 children aged 6–60 months undergoing cardiac surgery who were randomly assigned to receive bilateral transversus thoracis plane block (TTP group) or no nerve block. Up to 24 hours after extubation, the TTP group had a significantly lower MOPS than the control group, and the TTP group consumed significantly less fentanyl than the control group, with postoperative fentanyl consumption (ug/kg) in patients who underwent TTP block reaching 1.48 ± 0.43 in contrast to 3.98 ± 1.21 in the control group [19].