Use of Ultrasound-Guided Interfascial Plane Blocks in Anterior and Lateral Thoracic Wall Region as Safe Method for Patient Anesthesia and Analgesia: Review of Techniques and Approaches during COVID-19 Pandemic

Abstract

Ultrasound-guided interfascial plane blocks performed on the anterior and lateral thoracic wall have become an important adjuvant method to general anesthesia and an independent method of local anesthesia and pain management. These procedures diminish the harmful effects of anesthesia on respiratory function and reduce the risk of phrenic nerve paralysis or iatrogenic pneumothorax. In postoperative pain management, interfascial plane blocks decrease the dosage of intravenous drugs, including opioids. They can also eliminate the complications associated with general anesthesia when used as the sole method of anesthesia for surgical procedures. The following procedures are classified as interfascial plane blocks of the anterior and lateral thoracic wall: pectoral nerve plane block (PECS), serratus anterior plane block (SAP), transversus thoracic muscle plane block (TTP), pectoral interfascial plane block (PIF), and intercostal nerve block (ICNB). These blocks are widely used in emergency medicine, oncologic surgery, general surgery, thoracic surgery, cardiac surgery, orthopedics, cardiology, nephrology, oncology, palliative medicine, and pain medicine. Regional blocks are effective for analgesic treatment, both as an anesthesia procedure for surgery on the anterior and lateral thoracic wall and as an analgesic therapy after trauma or other conditions that induce pain in this area. In the era of the COVID-19 pandemic, ultrasound-guided interfascial plane blocks are safe alternatives for anesthesia in patients with symptoms of respiratory distress related to SARS-CoV-2 and appear to reduce the risk of COVID-19 infection among medical personnel.

Awake sternal fixation; comparison of technical details and early results with sternal fixation methods performed via general anaesthesia

“…In recent years, S-PIP has been used as an alternative to general anaesthesia in cardiac surgeries with high risk of general anaesthesia [ 20–22 ]. Szamborski et al reported that US-guided S-PIP can be safely preferred in thoracic surgery due to the risks of general anaesthesia procedures during the pandemic period [ 23 ]. Therefore, for the 1st time in our clinic, awake sternal fixation surgery using US-guided S-PIP with titanium plate was performed in a patient with high risk of general anaesthesia due to 2nd cervical vertebral fracture [ 10 ].…”

Regional Anesthesia for the Implantation of a Subcutaneous Implantable Cardioverter-Defibrillator Using Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block

“…Fascial anesthesia was initially developed as a component of multimodal anesthesia serving mainly as a method of intra- and postoperative analgesia [ 33 – 35 ]. However, some thoracic and abdominal fascial blocks can also be used as the sole method of anesthesia, mainly for less extensive procedures in the thoracic or abdominal region [ 36 , 57 ].…”

“…The transversus thoracic plane block is a problematic block due to the significant vascularization of the site where the block is performed (perforating, intercostal veins, and branches of the internal thoracic artery). In addition, the proximity of the vascular structures of the pleura and pericardium accounts for the difficulty of performing this type of anesthesia, especially when the patient is not under general anesthesia or sedation [ 36 , 57 ]. Although Abdelbaser et al [ 42 ] and Sepolvere et al [ 64 ] described the safety of the transversus thoracis plane block for patients who underwent open cardiac surgery, this applies to the implementation of the blockade in general anesthetized patients, in whom the risk of agitation of anxious patients or severe tachypnea in patients with cardiac failure were eliminated.…”

Regional anesthesia in the intensive care unit: a single center’s experience and a narrative literature review

“…Locoregional ultrasound-guided anaesthesia procedures enhanced the reliability of nerve block practice. Such improvements are also extremely useful as an aid or alternative to general anaesthesia in frail patients with reduced cardiorespiratory reserve or those taking chronic therapies with impact on haemostasis [26].…”