European Society of Anaesthesiology and Intensive Care Guidelines on peri-operative use of ultrasound for regional anaesthesia (PERSEUS regional anesthesia)

Abstract

Nowadays, ultrasound-guidance is commonly used in regional anaesthesia (USGRA) and to locate the spinal anatomy in neuraxial analgesia. The aim of this second guideline on the PERi-operative uSE of UltraSound (PERSEUS-RA) is to provide evidence as to which areas of regional anaesthesia the use of ultrasound guidance should be considered a gold standard or beneficial to the patient. The PERSEUS Taskforce members were asked to define relevant outcomes and rank the relative importance of outcomes following the GRADE process. Whenever the literature was not able to provide enough evidence, we decided to use the RAND method with a modified Delphi process. Whenever compared with alternative techniques, the use of USGRA is considered well tolerated and effective for some nerve blocks but there are certain areas, such as truncal blocks, where a lack of robust data precludes useful comparison. The new frontiers for further research are represented by the application of USG during epidural analgesia or spinal anaesthesia as, in these cases, the evidence for the value of the use of ultrasound is limited to the preprocedure identification of the anatomy, providing the operator with a better idea of the depth and angle of the epidural or spinal space. USGRA can be considered an essential part of the curriculum of the anaesthesiologist with a defined training and certification path. Our recommendations will require considerable changes to some training programmes, and it will be necessary for these to be phased in before compliance becomes mandatory.

Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study

“…However, the application of postoperative analgesia is still challenging due to high rates of degenerative liver and kidney functioning in elderly patients [ 4 , 5 ]. Although it is a traditional regional anesthesia technique, epidural anesthesia carries risks of hypotension, urinary retention, and epidural hematoma [ 6 , 7 ]. Opioid-based patient-controlled intravenous analgesia (PCIA) is also widely employed for relieving postoperative pain after colorectal surgeries [ 8 , 9 ].…”

Influence of Deep Serratus Anterior Plane Block on Chronic Pain at 3 Months After Breast-Conserving Surgery

“…6 The injections were carried out under ultrasound, under strict aseptic conditions, and according to recent European recommendations. 7 The ultrasound probe, with its sterile protection, was positioned on the anterior aspect of the thorax, at the deltopectoral groove. The pectoralis major and minor muscles were identified.…”

The effect of peripheral regional analgesia in thoracic surgery: a systematic review and a meta-analysis of randomized-controlled trials

“…Although many studies have evaluated the feasibility and effectiveness of these blocks in thoracic surgery, there is no evidence to date recommending the use of a specific block for a specific thoracic surgery procedure. 2 In this systematic review of the literature to evaluate the characteristics of the randomized controlled studies, we report the use of peripheral regional blocks in thoracic surgery, meta-analysing, wherever possible, the postoperative analgesic effect, using morphine equivalents (MME) taken in 24 hours as a comparison system.…”

“…Although many studies have evaluated the feasibility and effectiveness of these blocks in thoracic surgery, there is no evidence to date recommending the use of a specific block for a specific thoracic surgery procedure. 2…”