Time to Abandon the Term “3 in 1” Block

Moore, Christopher L.

doi:10.1016/j.annemergmed.2015.04.015

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…Same as FNB but a larger volume of LA is deposited, approximately 20-40 mL of LA. 9 Evidence. A prospective observational study has shown that 3in-1 block inconsistently blocks the ON (4% chance of blocking the ON).…”

Section: -In-1 Blockmentioning

confidence: 99%

Interventional therapies for management of hip fracture pain peri-operatively: A review article

Lim

Liu

Chan

2022

Proceedings of Singapore Healthcare

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Background Hip fracture is a common reason for elderly admission to hospital and majority of patients will require a hip fixation surgery. Pain originating from a hip fracture is usually severe and the need to improve comfort is paramount, especially before the hip fixation surgery because severe pain results in unnecessary stress response such as catecholamines release, tachycardia and hypertension. This worsens outcomes, increases risk of complications such as myocardial ischaemia, strokes, pulmonary embolus or deep vein thrombosis. Multimodal systemic analgesia has been shown to be effective in reducing pain in hip fractures but the associated side effects and contraindications have accelerated the adoption of nerve blocks in the peri-operative management of hip fracture patients. 1 As a result, this has been increasingly recognised as a important component of the hip fracture pathway (as part of a multimodal approach for analgesia) and many hospitals have protocols to perform various interventional therapies (various nerve blocks) for newly admitted patients with hip fracture to alleviate pain immediately and potentially provide intra and post-operative analgesia. Objective The aim of this review is to elucidate the various interventional therapies currently available (including pericapsular nerve group (PENG) block which was first described in 2018), their evidence and the pros and cons. Methods We reviewed the latest evidence for femoral nerve block (FNB), 3-in-1 block, lumbar plexus block (LPB), fascia iliaca block (FIB), erector spinae plane block (ESPB) and pericapsular nerve group (PENG) block. Results and conclusion Each block has its pros and cons, as discussed in this review article. The procedurist should deliberate these considerations before deciding which block is most appropriate.

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Section: -In-1 Blockmentioning

confidence: 99%

Interventional therapies for management of hip fracture pain peri-operatively: A review article

Lim

Liu

Chan

2022

Proceedings of Singapore Healthcare

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“…This hypothesis has not been confirmed and subsequent MRI studies have shown that there is a lateral and medial spread of local anaesthetic after injection, but not cephalad. It has been suggested that the block should better be referred to as '2 in 1' and the term '3 in 1' should be abandoned, as the obturator nerve is rarely blocked [14]. The femoral, obturator and lateral femoral cutaneous nerves can be blocked independently with USG guidance instead of a '3 in 1' block.…”

Section: '3 In 1' Blockmentioning

confidence: 99%

Current Concepts in Postoperative Pain Management Surgeries of Hip Joint: A Narrative Review

Gupta¹,

Kaushal²,

Malviya³

et al. 2022

IJRA

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Hip surgery is a common surgical procedure in the elderly and leads to significant pain postoperatively. The hip joint has a complex innervation which is unlikely to be covered with any single modality of pain relief. Multimodal analgesia has been critical in facilitating early recovery and rehabilitation in these patients. Regional analgesia is an important component of multimodal analgesia regimens and is instrumental in achieving optimal patient outcomes. Single shot or continuous central or peripheral nerve blocks provide effective and safe postoperative analgesia, lower opioid consumption, faster rehabilitation, and a high level of patient satisfaction. An ideal regional anaesthesia technique for hip surgery should be motor sparing while providing effective perioperative pain relief. Regional anaesthesia has seen enormous growth in the recent past due to advances in technology and research. These blocks have shown analgesic efficacy, have an opioid-sparing effect, and enable better patient positioning for central neuraxial blocks. Some of the novel interfascial plane blocks like Pericapsular Nerve Group (PENG) block are now being explored for hip analgesia. Within a few years of being described, these novel nerve blocks have seen tremendous favour in the literature and are being extensively used in the current practice of analgesia for hip surgery. In the present review, we aim to discuss the various modalities of analgesia which have been utilised in the past and would discuss few of the newer blocks for hip surgery. Keywords: Nerve blocks, Ultrasonography, Analgesics, Total hip arthroplasty, Fascia illiaca block, Multimodal analgesia, Transmuscular, Quadratus lumborum block

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“…Initial dye and X-ray studies showed that placement of an index finger below the needle insertion point assists LA solution movement into the natural gutter between the quadratus lumborum, psoas, and iliacus muscles but magnetic resonance imaging (MRI) proved otherwise (27). The terminology is under question and needs to be abandoned (28).…”

Section: The "3 In 1" Blockmentioning

confidence: 99%

Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

Maniar¹,

Macachor

Chiew

et al. 2021

Anesth Pain Med

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: A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The study described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.

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Time to Abandon the Term “3 in 1” Block

Cited by 7 publications

References 5 publications

Interventional therapies for management of hip fracture pain peri-operatively: A review article

Interventional therapies for management of hip fracture pain peri-operatively: A review article

Current Concepts in Postoperative Pain Management Surgeries of Hip Joint: A Narrative Review

Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

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