Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

Abstract

Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

Ultrasound-Guided Comparison of Psoas Compartment Block and Supra-Inguinal Fascia Iliaca Compartment Block for Pain Management in Pediatric Developmental Dysplasia of Hip Surgeries

“…This surgical operation may result in moderate-to-severe pain, which is an important risk factor for postoperative recovery of the hip structure and function. The femoral and obturator nerves and some branches of sciatic nerve innervate the surgical area, thus a satisfactory analgesic effect could be achieved by successful block of these peripheral nerves theoretically (14)(15)(16).…”

Prediction of nerve block success using ultrasonographic parameters: A preliminary animal study

“…An ultrasound (US)-guided nerve block is a type of regional anesthesia used for periprocedural analgesia in various medical elds such as orthopedics and endovascular treatment [1][2][3][4][5][6][7] . Since the nerve block technique requires ample time to elicit the required analgesic effect and its success rate is approximately 90% [8][9][10][11] , it is important to determine the success of a nerve block before a painful procedure is initiated.…”

Erector spinae plane block for postoperative analgesia. Caution: Meta‐analysis results do not equal science fact

“…1 It has been proposed that in order to determine the efficacy of fascial plane blocks in RCTs, an additional (non-block) control group is included that receives equivalent systemic LA levels to the block group. 3,5 Although current expert opinion is that systemic absorption of LA is unlikely to be a major mechanism of action for the ESPB, 6 it seems entirely appropriate that consideration is given to this possibility in the design of future studies on the efficacy of fascial plane blocks. 6 Until any potential contribution of systemically absorbed LA to analgesia outcomes have been elucidated, the results of studies where this has not been achieved should be interpreted with caution.…”