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

и другие.

Indian Journal of Anaesthesia, Год журнала: 2024, Номер 68(9), С. 832 - 833

Опубликована: Авг. 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.

Язык: 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

и другие.

British Journal of Anaesthesia, Год журнала: 2025, Номер unknown

Опубликована: Янв. 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).

Язык: Английский

Процитировано

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

и другие.

Regional Anesthesia & Pain Medicine, Год журнала: 2024, Номер unknown, С. rapm - 105430

Опубликована: Июнь 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 .

Язык: Английский

Процитировано

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

и другие.

Journal of Cardiothoracic and Vascular Anesthesia, Год журнала: 2025, Номер unknown

Опубликована: Фев. 1, 2025

Язык: Английский

Процитировано

1
Regional anesthesia in obese patients: Challenges, considerations, and solutions DOI Creative Commons

Alessandro De Cassai,

Francesco Zarantonello, Elisa Pistollato

и другие.

Saudi Journal of Anaesthesia, Год журнала: 2025, Номер 19(2), С. 221 - 226

Опубликована: Март 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.

Язык: Английский

Процитировано

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

Minerva Anestesiologica, Год журнала: 2025, Номер 91(3)

Опубликована: Апрель 1, 2025

Язык: Английский

Процитировано

1
Ultrasound-guided fascial plane blocks in chronic pain: a narrative review DOI Creative Commons
Francesco Marrone, Carmine Pullano, Alessandro De Cassai

и другие.

Journal of Anesthesia Analgesia and Critical Care, Год журнала: 2024, Номер 4(1)

Опубликована: Окт. 16, 2024

Recent studies have unveiled the intricate and distinctive nature of fascia, no longer regarding it solely as a muscle container. research highlights its complex innervation structure, signifying significance in chronic pain pathways.

Язык: Английский

Процитировано

4
Fascial plane blocks: from microanatomy to clinical applications DOI
Carmelo Pirri,

Debora Emanuela Torre,

Carla Stecco

и другие.

Current Opinion in Anaesthesiology, Год журнала: 2024, Номер 37(5), С. 526 - 532

Опубликована: Авг. 5, 2024

In the last 20 years, advancements in understanding of fasciae have significantly transformed anaesthesia and surgery. Fascial plane blocks (FPBs) gained popularity due to their validated safety profile relative ease. They are used various clinical settings for surgical nonsurgical indications. Growing evidence suggests a link between microscopic anatomy mechanism action. As result, knowledge these aspects is urgently needed better optimise pain management. The purpose this review summarise different deep/muscular fascia expand our performance FPBs.

Язык: Английский

Процитировано

3
Is the combination of interfascial plane blocks sufficient for awake breast cancer surgery? An observational, prospective, proof-of-concept study DOI Creative Commons

Gamze Ertas,

Hamiyet Senol Cakmak,

Sönmez Ocak

и другие.

BMC Anesthesiology, Год журнала: 2024, Номер 24(1)

Опубликована: Сен. 20, 2024

Breast cancer is the most prevalent among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast surgery has emerged as an alternative due to risks associated with anesthesia and patient preference.

Язык: Английский

Процитировано

3
The Sacral Multifidus Plane Block for Analgesia After Coccygectomy: Case Report DOI
Francesco Marrone, Pierfrancesco Fusco, Saverio Paventi

и другие.

A&A Practice, Год журнала: 2025, Номер 19(2), С. e01919 - e01919

Опубликована: Фев. 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.

Язык: Английский

Процитировано

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

и другие.

European Journal of Anaesthesiology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 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.

Язык: Английский

Процитировано

0