Radiological study to evaluate the spreading of two volumes (10 vs. 20 ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model

Varela, Olalla Cortizas; Melone, A; López-Menchaca, Ramiro; Sevilla, R.; Callejo, D.; López-Álvarez, S.; Fernández, A. Román; García, S.; Mantilla, Ignacio; Zaballos, M.

doi:10.1016/j.redare.2018.08.006

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Fernández et al (26) have suggested that SPBs can lead to the blockage of the last few intercostal nerves (T7-T11). Evidence from a pig model indicated that the administration of 10 mL of iopamidol showed a mean spreading of 2.28 ± 0.31 (95% CI: 2.01-2.54) to intercostal spaces, whereas the administration of 20 mL showed a spreading of 3 ± 0.25 to intercostal spaces (27). In our findings, we also demonstrated that the spread of the local anesthetic for 10.3% of the patients ranged from segmental nerves T2 to T9.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Pectoral Nerve Block I and Serratus-Intercostal Plane Block Alleviate Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

et al. 2019

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Background: Simultaneous application of pectoral nerve block and serratus-intercostal plane block (SPB) is one of the most desirable multimodal analgesic strategies, with wide implementation of the enhanced recovery after surgery pathway for modified radical mastectomy (MRM). Objectives: The aim of the present study was to investigate the efficacy and safety of ultrasoundguided pectoral nerve block I (PECS I) and SPB for postoperative analgesia following MRM. Study Design: A randomized, prospective study. Setting: An academic medical center. Methods: A total of 61 women undergoing MRM were randomly divided into 2 groups. The control group (group C, n = 32) received general anesthesia only, whereas the PECS I + SPB treated group (group PS, n = 29) received a combination of pectoral nerve block and SPB in addition to general anesthesia. Results: Pain scores on a visual analog scale, opioid consumption, the duration at the postanesthesia care unit, and the incidence of adverse events were lower in group PS, compared with that of the group C. Moreover, PECS I together with SPB contributed to better sleep quality and higher patient satisfaction of pain relief. Limitations: This study was limited by its sample size. Conclusions: These results suggest that the combination of PECS I and SPB provide superior perioperative pain relief in breast cancer surgery. Key words: Pectoral nerve block, serratus-intercostal plane block, postoperative analgesia, modified radical mastectomy

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Pectoral Nerve Block I and Serratus-Intercostal Plane Block Alleviate Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

et al. 2019

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“…Animal instrumentation was as previously described 13 – 15 . We used a closed-chest porcine experimental model that allowed reliable cardiac electrophysiological evaluation of cardiotoxicity of local anesthetic agents (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…All blocks were performed by a single person (O.V.) with knowledge and training in ultrasound-guided regional techniques and experience in performing SIFPB on pigs 14 , 15 . A GE 6–12 MHz linear array probe was used, and the blocks were performed with the animals positioned in supine.…”

Section: Methodsmentioning

confidence: 99%

Assessment of cardiotoxicity and plasma ropivacaine concentrations after serratus intercostal fascial plane block in an experimental model

Zaballos

Varela

Fernández

et al. 2023

Sci Rep

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Serratus intercostal fascial plane block (SIFPB) has emerged as an alternative to paravertebral block in breast surgery. It involves the administration of high volumes and doses of local anesthetics (LA) that can potentially reach toxic levels. Ropivacaine is widely used in thoraco-fascial blocks; however, there is no information on the plasma concentrations attained after SIPFB and whether they are associated with cardiotoxicity. Plasma concentrations of ropivacaine and its electrophysiological effects were evaluated in eight pigs after bilateral SIFPB with ropivacaine in doses of 3 mg/kg. Plasma concentrations, electrophysiological and hemodynamic parameters were measured sequentially for the following 180 min until the end of the study. The area under the curve, the maximum plasma concentration (Cmax) and the time to reach Cmax (tmax) were calculated. The median arterial ropivacaine concentration Cmax was, 2.34 [1.40 to 3.74] µg/ml. The time to reach the highest concentration was 15 [10 to 20] min. Twenty-five percent of the animals had arterial concentrations above the lower limit concentration of ropivacaine for LA systemic toxicity (3.4 µg/ml). No alterations were observed in the electrophysiological or electrocardiographic parameters except for a prolongation of the QTc interval, from 489 ± 30 to 544 ± 44 ms (Δ11.38 ± 6%), P = 0.01. Hemodynamic parameters remained in the physiological range throughout the study. SIFPB with ropivacaine in doses of 3 mg/kg has reached potentially toxic levels, however, it has not been associated with adverse electrophysiological or hemodynamic effects.

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“…In our experience, based on the innervation of the chest wall, performing a serratus intercostal block in the midaxillary line at the level of the fourth rib (BRILMA) is an opioid-saving technique that provides adequate analgesia for this type of surgery 2 and reduces the risk of chronic pain associated with this procedure 3 . We, therefore, believe that administering 2 effective blockades (PEC and BRILMA) 4 would overcome the analgesia deficit encountered with the authors’ technique.…”

mentioning

confidence: 99%

Fascial blocks in the COVID-19 era: An alternative to consider

Martín

Álvarez²

2022

Revista Española de Anestesiología y Reanimación (English Editi

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Radiological study to evaluate the spreading of two volumes (10 vs. 20 ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model

Cited by 6 publications

References 19 publications

Ultrasound-Guided Pectoral Nerve Block I and Serratus-Intercostal Plane Block Alleviate Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

Ultrasound-Guided Pectoral Nerve Block I and Serratus-Intercostal Plane Block Alleviate Postoperative Pain in Patients Undergoing Modified Radical Mastectomy

Assessment of cardiotoxicity and plasma ropivacaine concentrations after serratus intercostal fascial plane block in an experimental model

Fascial blocks in the COVID-19 era: An alternative to consider

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