Avoiding the Internal Mammary Artery During Parasternal Blocks: Ultrasound Identification and Technique Considerations

Sepolvere, Giuseppe; Tognú, Andrea; Tedesco, Mario; Coppolino, Francesco; Cristiano, Loredana

doi:10.1053/j.jvca.2020.11.007

Cited by 31 publications

(27 citation statements)

References 18 publications

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“…After coronary artery bypass grafting, patients can have tissue disruption in the transversus thoracis plane because of the internal mammary artery harvest, creating difficulties in transversus thoracis muscle identification. Subsequent reports have confirmed the high effectiveness of the block in the treatment of pain syndromes within the sternum region [ 34 , 35 , 36 ].…”

Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 90%

“…Due to the complicated technique and potential complications during its performance, the blockade technique has been modified, using safe anesthetics to perform it. Subsequent reports have confirmed the high effectiveness of the block in the treatment of pain syndromes within the sternum region [ 34 , 35 , 36 ].…”

Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 90%

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Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Szamborski

Janc

Rosińczuk

et al. 2022

IJERPH

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Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

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Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 90%

Section: Local Thoracic Plain Blocks—review Of Techniquesmentioning

confidence: 90%

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Szamborski

Janc

Rosińczuk

et al. 2022

IJERPH

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“…1B and 2B). [27]. Color-flow doppler is useful in probing IMA and it is usually observed in an ultrasound image aligned with costal cartilage plane.…”

Section: Deep Pip Blockmentioning

confidence: 99%

“…Because the internal mammary artery (IMA) and vein run over this muscle, to avoid inadvertent puncture, these vessels should be visualized and used as a landmark ( Fig. 1 and 2 ) [ 27 ]. Color-flow doppler is useful for probing the IMA, which is usually observed under translucent costal cartilage on an ultrasound image.…”

Section: Fascial Plane Blocks For Cardiac Surgerymentioning

confidence: 99%

Current evidence of ultrasound guided fascial plane blocks for cardiac surgery: a narrative literature review

Hong¹,

Oh²,

Jo³

et al. 2022

Korean J Anesthesiol

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“…Based on one study, pre and postincisional techniques appear to be comparable for postoperative pain management [56 ▪ ]. Of note, the transversus thoracis muscle is thin and ultrasound identification is commonly facilitated by locating the internal mammary artery (IMA), which runs just inferior to its border [57 ▪ ]. This has implications in cardiac surgery, as there is a theoretical risk of injury to the IMA, a common conduit for coronary artery bypass graft (CABG) surgery and procurement of the artery may prevent adequate identification of the structures necessary to perform the block.…”

Section: Parasternal Intercostal (Deep and Superficial) Plane Blockmentioning

confidence: 99%

Regional analgesia for cardiac surgery

Grant

Gregory

Ouanes

2022

Current Opinion in Anaesthesiology

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Purpose of review Regional anesthesia is gaining attention as a valuable component of multimodal, opioid-sparing analgesia in cardiac surgery, where improving the patient's quality of recovery while minimizing the harms of opioid administration are key points of emphasis in perioperative care. This review serves as an outline of recent advancements in a variety of applications of regional analgesia for cardiac surgery. Recent findingsGrowing interest in regional analgesia, particularly the use of newer ''chest wall blocks'', has led to accumulating evidence for the efficacy of multiple regional techniques in cardiac surgery. These include a variety of technical approaches, with results consistently demonstrating optimized pain control and reduced opioid requirements. Regional and pain management experts have worked to derive consensus around nerve block nomenclature, which will be foundational to establish best practice, design and report future research consistently, improve medical education, and generally advance our knowledge in this vital area of perioperative patient care.

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Avoiding the Internal Mammary Artery During Parasternal Blocks: Ultrasound Identification and Technique Considerations

Cited by 31 publications

References 18 publications

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Current evidence of ultrasound guided fascial plane blocks for cardiac surgery: a narrative literature review

Regional analgesia for cardiac surgery

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