Can we consider the fascia as the target of our fascial block? DOI Creative Commons
Pierfrancesco Fusco, Emanuele Nazzarro, Francesca De Sanctis

et al.

Indian Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 68(9), P. 832 - 833

Published: Aug. 16, 2024

Fascia blocks have gained popularity over the past two decades. Initially, fascia was considered a container to inject local anaesthetic. The only known mechanism of action anaesthesia nerve that runs inside fascial plane. However, anatomical and clinical studies eluded role in acute chronic pain.[1] microscopic physiological characteristics make it target not just for anaesthetic deposition. system comprises three-dimensional continuum soft, collagen-containing, loose dense fibrous connective tissues permeate body. As highlighted by Suarez-Rodriguez V et al., fasciae intrinsic innervation with Pacini Ruffini corpuscles and, above all, are rich free endings, so they believed be involved proprioception, balance perception pain.[2] Today, represents structure human body greatest number endings. It has been observed is increased pathological fasciae. Both execution perioperative treatment pain, must an important generator pain. genesis myofascial pain known, but ultrasound elasto-sonography recently revealed close relationship between administration reduction muscle stiffness transmission.[3] This article also highlights relief after block lasts much longer than effect itself. consideration led conclusion analgesic depends exclusively on anaesthetic, stimulating endings within fascia. In syndrome, such as may become either or electric mechanical stimuli 'dry needling'. confirmed warm saline solution alone plane patient suffering from which caused immediate pain.[4] If this were case, would transmission stimulation causes remodulation transmission. observation line anatomy intrafascial frequently perpendicularly oriented collagen fibres, thereby increasing likelihood their activation stretching fibres.[5] hydrodissection its objective breakdown hyaluronan macromolecules restore sliding fascia.[6] Fusco al.,[1] expert's opinion, success often unpredictable dependent several factors, including For example, septa inside, influence diffusion therefore, effectiveness block.[7] reason, performed dynamically break facilitate spread anaesthetic.[1] Considering open up new fields application management. Financial support sponsorship Nil. Conflicts interest There no conflicts interest.

Language: Английский

Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study DOI Creative Commons

Tingting Shan,

Xiaodan Zhang, Zhenyu Zhao

et al.

British Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Spread of local anaesthetic solution in the paravertebral space after erector spinae plane block (ESPB) is variable. We evaluated whether spread affected by patient position ESPB. randomised 84 patients to receive ESPB at T Local anaesthetic-contrast mix reached space, intercostal and neural foramina 96.5%, 94.2%, 77.9% individuals, respectively. Epidural occurred 20 cases. Prone positioning consistently allowed all patients, with more thoracic level compared supine (5.0 [1.9] vs 3.1 [1.7], difference [95% confidence interval, CI]: 1.9 [0.8-3.0] levels, P<0.001 for spread; 2.8 1.4 [1.4], CI] levels: [0.4-2.5], P=0.004 4.3 [1.3] 3.2 [1.5], 1.0 [0.1-1.9], P=0.019 spread). extended further prone than lateral group (4.3 2.6 [1.5] 1.7 [0.8-2.6], P<0.001). Sensory ventral dermatomes was variable participants. significantly enhanced foramina, suggesting that gravity plays a substantial role spread. Clinical Trials.gov (NCT06142630).

Language: Английский

Citations

3
Rectus sheath block added to parasternal block may improve postoperative pain control and respiratory performance after cardiac surgery: a superiority single-blinded randomized controlled clinical trial DOI
Alessandro Strumia, Giuseppe Pascarella, Domenico Sarubbi

et al.

Regional Anesthesia & Pain Medicine, Journal Year: 2024, Volume and Issue: unknown, P. rapm - 105430

Published: June 14, 2024

Background The population undergoing cardiac surgery confronts challenges from uncontrolled post-sternotomy pain, with possible adverse effects on outcome. While the parasternal block can improve analgesia, its coverage may be insufficient to cover epigastric area. In this non-blinded randomized controlled study, we evaluated analgesic and respiratory effect of adding a rectus sheath block. Methods 58 patients via median sternotomy were randomly assigned receive (experimental) or exit sites chest drains receiving surgical infiltration local anesthetic (control). primary outcome study was pain at rest extubation. We also assessed scores during exercises, opiate consumption performance first 24 hours after Results (IQR) maximum (on 0–10 Numeric Rate Scale (NRS)) extubation 4 (4, 4) in group 5 5) control (difference 1, p value=0.03). Rectus reduced opioid utilization by 2 mg over (IC 95% 0.0 2.0; p<0.01), NRS other time points, improved 6, 12, Conclusion addition improves analgesia for requiring emerging Trial registration number NCT05764616 .

Language: Английский

Citations

11
Acute Pain Management with Ultrasound-guided Erector Spinae Plane Block and Serratus Anterior Plane Block in Patients Undergoing Coronary Artery Bypass via Mini-thoracotomy: A Randomized Controlled Trial DOI
Xin Ling, Lu Wang, Yi Feng

et al.

Journal of Cardiothoracic and Vascular Anesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

Citations

1
Why the fascial blocks have to become dynamic DOI
Pierfrancesco Fusco, Emanuele Nazzarro

Minerva Anestesiologica, Journal Year: 2025, Volume and Issue: 91(3)

Published: April 1, 2025

Language: Английский

Citations

1
The Sacral Multifidus Plane Block for Analgesia After Coccygectomy: Case Report DOI
Francesco Marrone, Pierfrancesco Fusco, Saverio Paventi

et al.

A&A Practice, Journal Year: 2025, Volume and Issue: 19(2), P. e01919 - e01919

Published: Feb. 1, 2025

Coccygodynia results from traumatic, nontraumatic, or idiopathic causes. Chronic cases resistant to conservative treatments may necessitate surgery. This case report highlights the innovative use of sacral multifidus plane block (S-MPB) for multimodal pain management after a coccygectomy performed under spinal anesthesia. The patient, suffering chronic coccygodynia due exostosis, underwent surgical removal coccyx and associated fistula. S-MPB was chosen its simplicity, efficacy, safety, providing postoperative analgesia without complications. approach suggests that is promising addition arsenal coccygectomy, warranting further investigation optimize application outcomes.

Language: Английский

Citations

0
Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery DOI
Burhan Dost, Dario Bugada, Yunus Emre Karapınar

et al.

European Journal of Anaesthesiology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 12, 2025

BACKGROUND Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane pectoserratus (IP+PS) blocks have been used to relieve after breast surgery. OBJECTIVE In this systematic review meta-analysis trial sequential analysis, we aimed identify the optimal analgesic technique for achieving relief in The primary outcome of study was opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting movement scores 0, 6, 12 h, nausea vomiting (PONV), rescue requirements within first DESIGN A randomised controlled trials (RCTs) meta-regression analysis (TSA). DATA SEARCH We systematically searched Pubmed, Scopus, Cochrane Central Register Controlled Trials (CENTRAL), Web Science, Google Scholar, Medline (from inception until 1 October 2024). ELIGIBILITY CRITERIA RCTs that include patients undergoing PVB or IP+PS block, no language restriction. RESULTS Eighteen 924 were included. No difference MME h observed between two techniques; mean (MD) −1.94 (95% confidence interval (CI) −4.27 0.38, P = 0.101). Subgroup analyses revealed a minor advantage without axillary involvement; MD −2.42 CI −3.56 −1.29, < 0.001), though below threshold clinical significance. outcomes, including scores, PONV incidence comparable. Trial (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions. CONCLUSION offer comparable efficacy opioid-sparing effects surgery, meaningful differences 24-h consumption, incidence.

Language: Английский

Citations

0
Regional anesthesia for pediatric cardiac surgery: a review DOI Creative Commons
Burhan Dost, Alessandro De Cassai, Sara Amaral

et al.

BMC Anesthesiology, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 15, 2025

Effective pain management in pediatric cardiac surgery is essential for optimizing postoperative outcomes and promoting faster recovery. While intravenous analgesia remains a standard approach, regional anesthesia (RA) techniques have gained attention this population due to their analgesic efficacy, reduced dependence on systemic opioids, enhanced hemodynamic stability. This article provides an overview of current evidence RA surgery. We discuss the role management, outlining various techniques, such as epidural, paravertebral block, fascial plane blocks specific applications, clinical outcomes, challenges posed by anatomy pharmacokinetics. Pain assessment populations complications associated with are also explored. Despite demonstrated efficacy patient group, there need large-scale randomized multicenter studies establish standardized protocols strengthen base its use

Language: Английский

Citations

0
Performing fascial plane blocks dynamically to improve efficacy and safety DOI Creative Commons
Andrea Sanapo, Gian M. PETRONI, Francesca De Sanctis

et al.

Indian Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: 69(4), P. 413 - 414

Published: March 13, 2025

Language: Английский

Citations

0
Comparison of the analgesic efficacy of ultrasound-guided superficial serratus anterior plane block and intercostal nerve block for rib fractures: a randomized controlled trial DOI Creative Commons
Musa Zengіn, Onur Küçük, Mine Aslan

et al.

BMC Anesthesiology, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 13, 2025

Various regional analgesic methods are frequently incorporated into multimodal analgesia strategies for managing rib fractures. This study aimed to compare the efficacy of ultrasound-guided superficial serratus anterior plane block (S-SAPB) and intercostal nerve (ICNB) in patients with isolated randomized controlled trial included aged 18–65 years unilateral fractures (≤ 6 ribs) resulting from trauma. Patients underwent S-SAPB (20 ml 0.25% bupivacaine) or ICNB (3 bupivacaine each fractured rib). Pain levels were assessed using Visual Analogue Scale (VAS) both prior procedure (Pre-Block, (T0)) at specific time points following intervention: 1st hour (T1), 2nd (T2), 4th (T4), 8th (T8), 16th (T16), 24th (T24). The changes observed values over expressed as delta (Δ). Both provided effective analgesia. In first 4 h, demonstrated a greater reduction VAS scores, particularly 10th 11th However, resulted significantly longer-lasting analgesia, pain relief after 8 h (T8–T24) compared (p < 0.05). group required no additional whereas 43.3% supplemental tramadol 0.001). techniques well tolerated, reported complications. provides prolonged may be preferable fracture beyond initial h. offers superior early postoperative period, especially lower (10th–11th ribs). A combined approach that includes blocks optimize control multiple involving ribs.

Language: Английский

Citations

0
Regional anesthesia in obese patients: Challenges, considerations, and solutions DOI Creative Commons

Alessandro De Cassai,

Francesco Zarantonello, Elisa Pistollato

et al.

Saudi Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: 19(2), P. 221 - 226

Published: March 25, 2025

The increasing global prevalence of obesity has significant implications for anesthesiologists, particularly in the context regional anesthesia. Anesthesiologists face numerous challenges during anesthesia obese patients, including compromised respiratory function, altered pharmacokinetics local anesthetics, and difficulties identifying anatomical landmarks. Obesity often leads to reduced reserve, increased risk hypoventilation, conditions such as obstructive sleep apnea syndrome hypoventilation syndrome, which increase likelihood postoperative complications. Additionally, body composition patients affects distribution requiring adjustments dosing based on lean weight rather than total weight. Furthermore, excess adipose tissue complicates identification landmarks use ultrasound block procedures, depth image resolution hinder needle placement. Proper positioning, low-frequency transducers, harmonic imaging techniques are essential optimizing guidance. longer needles application trigonometric calculations scans can help determine appropriate length. To overcome these challenges, anesthesiologists should adopt strategies that involve adjusting drug dosages, utilizing specialized equipment, continuously monitoring potential A holistic approach involving knowledge technical pathological well adapting is crucial ensuring safety effectiveness patients.

Language: Английский

Citations

0