Pathways of anesthetic from the thoracic paravertebral region to the celiac ganglion

Tanuma, Kumiko; Den, S.; Tanuma, Yutaka; Miyakawa, Kunihisa; Carney, Edward; Carlsson, Christer

doi:10.1002/ca.10036

Cited by 13 publications

(4 citation statements)

References 15 publications

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“…The lateral femoral cutaneous, obturator and femoral nerves emerge from the lateral aspect of psoas major at a more caudal location. Case reports and cadaveric studies indicate that fluid can track caudally from the thoracic paravertebral space under the arcuate ligaments of the diaphragm and into the lumbar paravertebral space [24][25][26]. The genitofemoral nerve emerges medially and caudally from the psoas major muscle and was, thus, unstained in the majority of specimens.…”

Section: Discussionmentioning

confidence: 99%

A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

et al. 2016

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We performed bilateral transmuscular quadratus lumborum blocks in six cadavers using iodinated contrast and methylene blue. Computed tomography imaging was performed in four cadavers and anatomical dissection was completed in five. This demonstrated spread to the lumbar paravertebral space in 63% of specimens, laterally to the transversus abdominis muscle in 50% and caudally to the anterior superior iliac spine in 63% of specimens. There was no radiographic evidence of spread to the thoracic paravertebral space. Anatomical dissection revealed dye staining of the upper branches of the lumbar plexus and the psoas major muscle in 70% of specimens. Further clinical studies are required to confirm if the quadratus lumborum block might be a suitable alternative to lumbar plexus block.

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Section: Discussionmentioning

confidence: 99%

A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

et al. 2016

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“…A local anesthetic injected anterior to the quadratus lumborum muscle and posterior to the transverse fascia probably spreads into the thoracic paravertebral space, posterior to the lateral arch and medial and ligaments of the diaphragm, along the internal thoracic fascia and blocks the inferior thoracic sympathetic trunk and somatic nerves [ 60 ]. In addition to the current anatomic and clinical literature, two recent studies support this mechanism of action in blocking the anterior quadratus lumborum [ 22 , 61 , 62 , 63 ]. Although the mechanism of action of rectus sheath blockade remains unclear, there is evidence that postoperative release of the proinflammatory cytokine IL-6 is increased in patients after general and spinal anesthesia [ 39 ].…”

Section: Resultsmentioning

confidence: 94%

“…The 17 included papers were published between 1996 and 2020, and virtually all mentioned different approaches to the treatment of POP in children with LA, i.e., lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis block (UGTAP), ultrasound-guided quadratus lumborum block (UGQLB), and comparison of open appendectomy (OA) with LA in relation to the treatment of POP in children [ 7 , 10 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. As shown in Table 1 , a total of 1754 samples were included in the study, of which 61.86% were male.…”

Section: Resultsmentioning

confidence: 99%

“…Given the widespread problem, there is relatively little research on the POP perceptions of children undergoing LA. Even though there is a standard of pain management, it is unclear whether or not this has resulted in a better hospital experience for children [ 22 , 23 ]. A plausible explanation is that the procedure is considered comparatively minor, with no tissue damage and rapid recovery.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

et al. 2023

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Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

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A review of the thoracic splanchnic nerves and celiac ganglia

et al. 2010

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Anatomical variation of the thoracic splanchnic nerves is as diverse as any structure in the body. Thoracic splanchnic nerves are derived from medial branches of the lower seven thoracic sympathetic ganglia, with the greater splanchnic nerve comprising the more cranial contributions, the lesser the middle branches, and the least splanchnic nerve usually T11 and/or T12. Much of the early anatomical research of the thoracic splanchnic nerves revolved around elucidating the nerve root level contributing to each of these nerves. The celiac plexus is a major interchange for autonomic fibers, receiving many of the thoracic splanchnic nerve fibers as they course toward the organs of the abdomen. The location of the celiac ganglia are usually described in relation to surrounding structures, and also show variation in size and general morphology. Clinically, the thoracic splanchnic nerves and celiac ganglia play a major role in pain management for upper abdominal disorders, particularly chronic pancreatitis and pancreatic cancer. Splanchnicectomy has been a treatment option since Mallet-Guy became a major proponent of the procedure in the 1940s. Splanchnic nerve dissection and thermocoagulation are two common derivatives of splanchnicectomy that are commonly used today. Celiac plexus block is also a treatment option to compliment splanchnicectomy in pain management. Endoscopic ultrasonography (EUS)-guided celiac injection and percutaneous methods of celiac plexus block have been heavily studied and are two important methods used today. For both splanchnicectomies and celiac plexus block, the innovation of ultrasonographic imaging technology has improved efficacy and accuracy of these procedures and continues to make pain management for these diseases more successful.

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Pathways of anesthetic from the thoracic paravertebral region to the celiac ganglion

Cited by 13 publications

References 15 publications

A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

A radiologic and anatomic assessment of injectate spread following transmuscular quadratus lumborum block in cadavers

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

A review of the thoracic splanchnic nerves and celiac ganglia

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