FIGURE 1 - uploaded by Hesham A Elsharkawy
Content may be subject to copyright.
Image illustrating the 2 fascial connective layers: superficial fascia and deep fascia. Reproduced with granted permission from Stecco et al. 16
Source publication
Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fasc...
Contexts in source publication
Context 1
... deep fascia is composed of multiple layers and repre- sents the target for interfascial plane blocks. 7 The deep fascia is a membrane that extends throughout the whole body and is kept under basal tension via numerous muscular attachments. It is de- void of fat and forms sheaths for the nerves and vessels and en- velops various organs. The deep fascia is independent of the underlying muscle, separated from it by the epimysium and a layer of loose connective tissue (Fig. ...
Context 2
... deep fascia is composed of multiple layers and repre- sents the target for interfascial plane blocks. 7 The deep fascia is a membrane that extends throughout the whole body and is kept under basal tension via numerous muscular attachments. It is de- void of fat and forms sheaths for the nerves and vessels and en- velops various organs. The deep fascia is independent of the underlying muscle, separated from it by the epimysium and a layer of loose connective tissue (Fig. ...
Similar publications
Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The pu...
Citations
... Fascia blocks are effective analgesia methods that anesthesiologists have used in surgical or post-surgical procedures for years. With the understanding of the importance of fascial tissue in the last 10 years, the use of interfascial injections has managed to attract the attention of other disciplines [1,2]. The majority of pain in the anterior hip region is caused by myofascial pain, and intramuscular trigger point injections have an important role in their treatment. ...
... 7 In addition to the numerous factors which could affect the fascial plane blocks, Elsharkawy et al. described the basics of facial plane, and how many factors could influence the effectiveness, the quality and the spread of the block. 8 Site of injection, volume of local anesthesia used, biomechanical properties of fascia, types of fascia and fascial layers and many other factors could influence the dermatomal spread and quality of the block. 8 Raising the question of how well we understand and do the fascial plane block? ...
... 8 Site of injection, volume of local anesthesia used, biomechanical properties of fascia, types of fascia and fascial layers and many other factors could influence the dermatomal spread and quality of the block. 8 Raising the question of how well we understand and do the fascial plane block? To better understand the value of these factors, for example the site of injection in Phan VTN, et al sugammadex on deep neuromuscular blockade www.apicareonline.com ...
... In recent years, interfascial plane blocks have garnered significant interest as a central strategy for perioperative pain management in human and veterinary medicine [5][6][7][8][9][10]. These novel regional anesthetic techniques have shown efficacy in controlling intraoperative nociception and contributing to a comfortable, pain-free recovery period [5][6][7][8][9][10]. ...
... In recent years, interfascial plane blocks have garnered significant interest as a central strategy for perioperative pain management in human and veterinary medicine [5][6][7][8][9][10]. These novel regional anesthetic techniques have shown efficacy in controlling intraoperative nociception and contributing to a comfortable, pain-free recovery period [5][6][7][8][9][10]. In cats, ultrasound-guided regional anesthetic techniques have been proposed to offer additional perioperative pain control following ovariectomy [5][6][7]11]. ...
... It involves the deposition of a local anesthetic solution in the interfascial plane between the quadratus lumborum and psoas muscles [12,13]. The QLB appears to offer an adequate level of analgesia for abdominal procedures in several species [5][6][7][8][9][14][15][16]. In cats undergoing ovariectomy, the QLB has been shown to reduce opioid administration, the need for intraoperative rescue analgesia, and the postoperative pain scores [5][6][7]. ...
Simple Summary
Interfascial plane blocks have gained significant attention as a key approach for managing perioperative pain. However, there is limited research on the utilization of a bilateral ultrasound-guided quadratus lumborum block (QLB) on opioid consumption during intraoperative nociception in cats undergoing elective ovariectomy. This study used 32 feral cats that were randomly assigned to a control group (C) or a QLB group. The QLB group received 0.4 mL kg⁻¹ of 0.25% bupivacaine per hemiabdomen. Hemodynamic parameters, including heart rate (HR) and respiratory rate (RR), were recorded at five intraoperative time points. Fentanyl was administered if a 20% increase in HR or RR was observed. Results showed that the HR and RR were significantly higher in the control group compared to the QLB group during ovarian manipulation. However, no significant differences were found in systolic or mean arterial pressure between the two groups, and hypotension rates were similar. Importantly, the QLB group required significantly less intraoperative fentanyl compared to the C group. A bilateral QLB with bupivacaine effectively reduces opioid consumption in the study population of cats undergoing elective ovariectomy. This technique may improve pain management and reduce opioids during surgery.
... ESPB can deeply inject local anesthetics into the fascial plane between the transverse process of the vertebral body and the erector spinae muscle. 2 Leveraging the interconnected nature of the erector spinae muscle's fascial planes across the thoracic and lumbar segments, local anesthetics are able to disperse both cranially and caudally. This distribution effectively blocks the posterior branches of the spinal nerve within a defined range, with a blocking range of T 8~S2 . ...
Background
The erector spinae plane block (ESPB) has been increasingly utilized for postoperative analgesia in thoracic, abdominal, and spinal surgeries. This study evaluated the postoperative analgesic outcomes of ESPB with nalbuphine as a ropivacaine adjuvant for lumbar trauma surgery.
Methods
This randomized double-blind clinical trial included 57 participants who underwent lumbar trauma surgery. Ultrasound-guided ESPB was performed with 0.375% ropivacaine (Group R) and 0.375% ropivacaine combined with 10 mg nalbuphine (Group N); 20 mL was used per side. The primary outcome measure was the time to first postoperative remedial analgesia. The secondary outcome measures included the Numerical Rating Scale (NRS) scores at rest and during movement, cumulative sufentanil consumption after surgery, intraoperative dosage of remifentanil and sufentanil, time to first off-bed, time to first flatus, and length of hospital stay.
Results
The mean difference in the time to first postoperative remedial analgesia (Group N vs Group R, 489±52 min vs 391±23 min) was 98 min (95% CI, 76 to 119). Kaplan–Meier survival analysis revealed an increasing pain-free population in Group N and an increasing pain-free duration. The log-rank (Mantel–Cox) test showed that the hazard ratio (HR, Group N/Group R) was 0.225 (95% CI, 0.114 to 0.443). Group N showed decreased sufentanil consumption compared with Group R at 4–8 h, 8–12 h and 0–24 h after surgery (P<0.001).
Conclusion
ESPB with nalbuphine in combination with ropivacaine significantly prolonged the duration of analgesia and reduced postoperative analgesic demands compared to ropivacaine alone.
... • Prolonged duration of analgesia • Reduced opioid requirement and opioid-associated adverse effects • Shorter hospital stay 68 A PNC can be left in situ for up to 7 days; however, each additional day beyond the fourth day increases the risk of catheter-related infection. 13 When deciding upon the duration of catheter use, the analgesic benefits should be weighed against the risk of infection. ...
Effective pain management in neonates is critical, as inadequate treatment can result in both immediate complications and long-term cognitive and behavioral issues. Neonates, particularly preterm infants, have heightened sensitivity to pain, which necessitates the use of specialized pain management techniques. Regional anesthesia (RA) offers significant benefits in this patient population, including reducing the need for opioids and their associated risks, minimizing the stress response, and improving postoperative outcomes. Despite its proven efficacy in pediatric and adult populations, there is limited published evidence regarding RA's use in neonates. This article reviews the fundamental science, clinical applications, and safety considerations of regional anesthesia in neonates, focusing on four modalities: neuraxial blocks, peripheral nerve blocks, fascial plane blocks, and analgesic catheters. While RA has been shown to provide superior pain control and reduce opioid consumption, safety is paramount, especially considering the unique physiological characteristics of neonates.
... Local anesthetic systemic toxicity is one of the most important problems in regional LA applications and it is important to detect findings early and intervene [35]. The limits of LA spread in application areas in plane blocks cannot be clearly explained [36]. Depending on the type of block applied, fascia thickness is an important determinant. ...
Background/aim
Thoracic paravertebral block (TPVB) is a well-established procedure for the management of postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). In recent years, there have been studies suggesting that fascial plane blocks may be an alternative to TPVB. The objective of our study was to determine the efficacy of combined deep and superficial serratus anterior block (C-SAPB) as an alternative to TPVB in the management of postoperative analgesia in VATS.
Materials and methods
The patients were divided into two groups: the TPVB group and the C-SAPB group. Both groups were administered the same dose of local anesthetics. Multimodal analgesia was achieved for the groups. The primary outcome measure was visual analog scale (VAS) pain scores recorded within the first 48 h of the postoperative period in each group. The secondary outcomes were analgesic requirement, rescue analgesics, complications rate, and postoperative patient satisfaction.
Results
Thirty patients with C-SAPB and 30 patients with TPVB were analysed. VAS rest and VAS coughing scores were similar between the groups (p > 0.05). Demographic and side effect conditions, total morphine use, additional analgesic needs, vital parameters, block procedure time, and patient satisfaction were also similar between the groups (p > 0.05). Additionally, although block application times were comparable, the time was slightly shorter in C-SAPB.
Conclusion
Similar analgesic efficacy was observed between C-SAPB and TPVB. TPVB maintains its place among the first choices in VATS. The efficacy of C-SAPB is comparable to that of TPVB. While the duration of C-SAPB application is not a significant factor, the brief nature of the procedure and its straightforward administration suggest that it may be an effective method.
... Interfascial plane blocks are analgesic techniques used for acute peri-operative pain and chronic pain [2]. An interfascial plane block is a regional nerve block that uses a particular fascial plane as the target for the deposition of a local anaesthetic, causing it to diffuse throughout a potential space and impact one or more neuronal targets [3]. Erector spinae plane blocks and rectus sheath blocks are examples of interfascial plane blocks that are utilised as part of a multimodal postoperative analgesia approach after abdominal surgeries [3]. ...
... An interfascial plane block is a regional nerve block that uses a particular fascial plane as the target for the deposition of a local anaesthetic, causing it to diffuse throughout a potential space and impact one or more neuronal targets [3]. Erector spinae plane blocks and rectus sheath blocks are examples of interfascial plane blocks that are utilised as part of a multimodal postoperative analgesia approach after abdominal surgeries [3]. ...
Introduction
The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound‐guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low‐ and middle‐income country.
Methods
We allocated randomly 72 patients aged 18–65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events.
Results
Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13–17) h vs. 12 (11–13) h, respectively; p < 0.001). There were no block‐related complications in either group.
Discussion
Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid‐sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low‐and middle‐income countries.
... The transversus abdominis plane block [TAPB] and the quadratus lumborum block [QLB] are new techniques of truncal plane blocks, and their roles in post-CS analgesia are still under investigation [1] . US-guided quadratus lumborum block is a type of fascial plane block where local anesthetic is injected adjacent to the quadratus lumborum muscle with the goal of blocking the thoracolumbar nerves [6] . ...
... The expansion covering the sciatic and posterior femoral cutaneous nerves is very thin, and its observations coincide with those of previous anatomical studies [7]. We would like to highlight that this fascial structure could be used for a sciatic nerve block, which has been described for other areas and other nerves [33][34][35][36], with lower risk of nerve damage. However, the fibrosis of these fascial expansions can be observed in hamstring syndrome and could cause nerve compression at this level [37]. ...
Background: Injuries of the proximal attachment of the hamstring muscles are common. The present study aimed to investigate the relationship of the proximal attachment of the hamstring muscles with neighboring structures comprehensively. Methods: A total of 97 hemipelvis from 66 cryopreserved specimens were evaluated via ultrasound, anatomical and histological samples. Results: The proximal attachment of the hamstring muscles presents a hyperechogenic line surrounding the origin of the semimembranosus and the long head of the biceps femoris muscles, as well as another hyperechogenic line covering the sciatic nerve. The anatomical and histological study confirms the ultrasound results and shows different layers forming the sacrotuberous ligament. Furthermore, it shows that the proximal attachment of the semimembranosus muscle has a more proximal origin than the rest of the hamstring muscles. Moreover, this muscle shares fibers with the long head of the biceps femoris muscle and expands to the adductor magnus muscle. The histological analysis also shows the dense connective tissue of the retinaculum covering the long head of the biceps femoris and semimembranosus muscles, as well as the expansion covering the sciatic nerve. Conclusions: These anatomical relationships could explain injuries at the origin of the hamstring muscles.
... 17 Elsharkawy et al. illustrated that the retrolaminar space is connected laterally to the interfacial plane between the serratus anterior and external intercostal muscles, where the lateral cutaneous branch runs. 18 Therefore, blocking the lateral cutaneous branch by RLB could contribute to the postoperative analgesia following breast cancer surgery. ...
Background & objective: Modified radical mastectomy (MRM) is the most commonly performed surgical procedure in breast cancer patients and is usually associated with severe postoperative pain. The peripheral nerve block techniques have been suggested in addition to the traditional opioid and non-opioid analgesics to manage acute post-mastectomy pain. We compared the analgesic efficacy of retrolaminar block (RLB) with erector spinae plane block (ESPB) in patients undergoing MRM, with an aim to establish the efficacy of one over the other.
Methods: This randomized single-blind study included 60 female patients scheduled for MRM under general anesthesia and randomized into two equal groups. The RLB Group (n = 30) received a preoperative ultrasound-guided RLB with 20 ml levobupivacaine 0.25%. The ESPB Group (n = 30) received an ESPB with 20 ml levobupivacaine 0.25%. The primary outcome measure was the total postoperative morphine consumption. Secondary outcomes were total intraoperative fentanyl consumption, duration of analgesia, pain intensity (NPRS score), hemodynamic changes, and adverse effects.
Results: The intraoperative fentanyl and postoperative morphine consumption were lower in the ESPB group than the RLB group, but the difference was near statistical significance (P = 0.066 and 0.058, respectively). Pain intensity at rest and on movement was comparable in both groups in the postoperative period, except that NPRS on movement was significantly lower in the ESPB group compared to RLB group (P = 0.039). Both techniques offered hemodynamic stability and there was no significant difference in the occurrence of PONV (P = 0.559).
Conclusion: Ultrasound-guided single-point retrolaminar block and erector spinae plane block are safe and effective postoperative analgesic techniques for patients undergoing modified radical mastectomy with comparable effects in terms of opioid consumption, duration of analgesia, pain intensity, and occurrence of PONV.
Abbreviations: BMI - body mass index; ESPB - erector spinae plane block; ESM - erector spinae muscle; MRM - Modified radical mastectomy; NPRS - Numerical pain rating scale; RLB - retrolaminar block;
Keywords: Analgesics; Opioids; Breast Neoplasms; Postoperative Pain; Mastectomy; Nerve block
Citation: Soliman AM, Zaghloul A, Mohamed MS, Ahmed MB. Analgesic efficacy of ultrasound-guided retrolaminar block and erector spinae plane block in modified radical mastectomy: A randomized controlled study. Anaesth. pain intensive care 2024;28(3):465−471; DOI: 10.35975/apic.v28i3.2464
