Interfascial Plane Blocks

Elsharkawy, Hesham; Pawa, Amit; Mariano, Edward R.

doi:10.1097/aap.0000000000000750

Cited by 177 publications

(100 citation statements)

References 41 publications

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“…The other two important points are sensory block level and the mechanism by which the local anesthetic drugs acts. The mechanism of action has been focused on for ganglion blockade, sympathetic block, and paravertebral spread [28,29]. In the literature, there are many predictions that drugs administered to the fascial plane may lead to variations in the spread due to biomechanical effects.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ökmen

2020

Korean J Anesthesiol

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Background:The quadratus lumborum block (QLB), which is reported to provide analgesia to the abdominal region, is a newly defined fascial plane block method. The present study aimed to investigate the effect of ultrasound guided anterior QLB on the postoperative pain scores after percutaneous nephrolithotomy (PNL). Methods: In this prospective, randomized, controlled single-blind study, 60 patients with PNL operations were randomized into 2 groups. In Group B (n = 30): anterior QLB+ intravenous patient-controlled analgesia (PCA) morphine and in Group C (n = 30): intravenous PCA morphine. Outcome measures were included for visual analog scale (VAS) scores and cumulated consumption for 24 hours postoperatively. Adverse effects, additional analgesic requirement, and intraoperative opioid requirement were recorded. Results: The mean values of the quantity of cumulated morphine used at the 6th, 12th, and 24th hours were found to be statistically significantly lower in Group B (P < 0.05). The VAS scores were found to be statistically significantly lower in Group B (P < 0.05). There were no statistically significant differences in the rate of adverse effects, additional analgesic requirement, and intraoperative opioid requirement between the groups. Conclusions:The study results suggest that anterior QLB is an effective treatment option for postoperative analgesia of PNL.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ökmen

2020

Korean J Anesthesiol

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“…4B) suggests that RLB is an interfascial plane block, spreading between the laminar and transversospinalis muscles. Recently, Elsharkawy et al (2018) described, based on anatomy, that a retrolaminar space continued laterally to the interfacial plane between the serratus anterior and external intercostal muscles, in which the lateral cutaneous branch runs. Blockade of the lateral cutaneous branch by RLB might partially provide postoperative analgesia for breast cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial

Onishi

Murakami

Nishino

et al. 2018

Tohoku J. Exp. Med.

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Thoracic epidural anesthesia (TEA) and paravertebral block (PVB) have been performed for perioperative regional anesthesia in the trunk. However, TEA and PVB are associated with a risk of serious complications, such as pneumothorax, hypotension, or nerve damage. Retrolaminar paravertebral block (RLB) was introduced as a new alternative to PVB. This new approach might lower the risk of serious complications, but its use has not been well established yet. Therefore, we conducted a double-masked, placebo-controlled, randomized clinical trial to evaluate the efficacy of a double-level RLB for postoperative analgesia after breast cancer surgery. A total of 122 women who underwent breast cancer surgery with axillary lymph node dissection under general anesthesia were allocated into RLB group (60 patients) and Control group (62 patients). RLB was performed upon surgery completion with 15 ml ropivacaine (0.5%) for each lamina of the T2 and T4 vertebrae. In Control group, the same volume of normal saline was injected at each level. The time to first postoperative analgesic administration was significantly longer in RLB group than that in Control group (161.5 min vs. 64.0 min). The pain score in RLB group was significantly lower immediately after surgery. However, the number of patients requiring analgesics during the 12-hour post-surgical period was similar between RLB group (20 patients) and Control group (22 patients). In conclusion, the double-level RLB could delay the time to initial administration of analgesics, but this technique may be insufficient to reduce the analgesic requirement within the 12-hour postoperative period following breast cancer surgery.

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“…The abdominal wall is anatomically complex with regard to the relation between muscles, fascial layers, the planes between them and the segmental origins of intercostal branches of the rectus sheath plexus. 2,11,12 We did not correlate the medication spread with numbness and pain scores. We wanted to improve our patient care making sure that the spread of anesthetic matches the surgical incision.…”

Section: Limitations Of the Studymentioning

confidence: 83%

Single injection ultrasound‐guided rectus sheath blocks for children: Distribution of injected anesthetic

Visoiu

Hauber

Scholz

2019

Pediatric Anesthesia

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Summary Background Single injection ultrasound‐guided rectus sheath blocks are used for postoperative analgesia after midline abdominal incisions, but the ultrasonographic spread of medication posterior to the rectus muscle has not been investigated. Aims The primary goal of this study was to determine the ultrasound‐measured medication spread superiorly and inferiorly after single injection ultrasound‐guided rectus sheath blocks and to calculate the incidence of cases with spread up to the subcostal margin and below of umbilicus. The secondary goals were to correlate the spread with the volume of medication administered and with the patient's age, weight, height, sex, and body mass index. Methods Pediatric patients who underwent single injection ultrasound‐guided rectus sheath blocks and underwent data collection of ultrasonographic information on medication spread along the plane of the posterior rectus sheath were identified retrospectively from an acute pain service database at UPMC Children's Hospital of Pittsburgh. Results Sixty‐eight children, 10.2 ± 4.2 (mean ± SD) years old, 41.7 ± 17.9 kg, 140 ± 24.6 cm, had complete data collection. Mean injected volume of ropivacaine was 8.3 ± 2.8 mL (right) and 8.2 ± 2.8 mL (left). The average spread was measured as 3.9 ± 1.4 cm (right) and 3.4 ± 1.3 cm (left) cranial to the umbilicus, and 1.5 ± 1.6 cm (right) and 1.6 ± 1.4 cm (left) caudal to the umbilicus. Complete spread up to the level of the subcostal margin was observed in 52.9% (n = 36; right) and 36.8% (n = 25; left) of cases. The spread correlated closely with the volume of injected ropivacaine (right: 0.556, P < 0.001; left: 0.541, P < 0.001). The spread below umbilicus was 70.6% (n = 48, right) and 80.9% (n = 55, left). There was a positive strong correlation (P < 0.001) between total medication spread and age (right: 0.608; left: 0.538), weight (right: 0.600; left: 0.540), and height (right: 0.593; left: 0.526). Conclusion After single injection ultrasound‐guided rectus sheath blocks, incomplete cephalocaudal medication spread can be expected within the posterior rectus sheath.

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Interfascial Plane Blocks

Cited by 177 publications

References 41 publications

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Ultrasound-guided anterior quadratus lumborum block for postoperative pain after percutaneous nephrolithotomy: a randomized controlled trial

Analgesic Effect of Double-Level Retrolaminar Paravertebral Block for Breast Cancer Surgery in the Early Postoperative Period: A Placebo-Controlled, Randomized Clinical Trial

Single injection ultrasound‐guided rectus sheath blocks for children: Distribution of injected anesthetic

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