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Xavier Sala-Blanch

Xavier Sala-Blanch
Hospital Clínic. University of Barcelona · Anesthesia

M.D.

About

253
Publications
53,394
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2,914
Citations
Citations since 2017
94 Research Items
1321 Citations
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2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250
2017201820192020202120222023050100150200250

Publications

Publications (253)
Article
Genicular nerves block is a promising technique to treat acute postoperative pain in total knee arthroplasty. Similar to surgeon-administered local infiltration analgesia, it targets sensory branches from the knee capsule, but through a selective ultrasound-guided injection that reduces local anaesthetic dose (150 ml ropivacaine 0.2% with local inf...
Article
Introduction Inadvertent intraneural injection is not infrequent during peripheral nerve blocks. For this reason, injection pressure monitoring has been suggested as a safeguard method that warns the clinician of a potentially hazardous needle tip location. However, doubts remain whether it is superior to the sonographic nerve swelling in terms of...
Article
Total knee arthroplasty is one of the most frequently performed orthopaedic surgeries. However, up to 20% of patients develop persistent postoperative pain. Persistent postoperative pain may be an extension of acute postoperative pain, but can also occur after more than 3 months without symptoms. Risk factors associated with persistent postoperativ...
Conference Paper
Background and Aims Inadvertent intraneural injection is not infrequent during peripheral nerve blocks. To this end, injection pressure monitoring is suggested as a safeguard method that warns of a potentially hazardous needle tip location. However, doubts remain if this method is superior to the sonographic nerve swelling in terms of earlier detec...
Conference Paper
Deliberate or inadvertent intraneural injection may be associated with a variety of neurologic complications. Intraneural injection has traditionally been subdivided into intrafascicular or extrafascicular injection. In the latter instance, the injected solution spreads between the fat cells without breaking or disturbing them, causing the nerve to...
Conference Paper
Background and Aims Continuous peripheral nerve blocks (cPNB) are widely used and have potential benefits for providing pain relief for several days. Successful insertion of cPNBs and avoidance of their dislocation can represent a challenge.Dislocation of cPNBs can result in failure of the block and is poorly described in the literature. The rate o...
Article
Introduction: Ultrasonography is useful for detecting intraneural injections. However, the reliability of the sonographic findings of intraneural and subparaneural injections in terms of true spread location and their association with intrafascicular deposits has not been systematically evaluated. Evidence acquisition: Our objectives were: i) to...
Chapter
The cervical plexus and its branches are situated in the lateral aspect of the neck between the sternocleidomastoid and trapezius muscles. The following images depict a step-by-step dissection of the cervical plexus and its branches.
Chapter
Spinal anesthesia can be affected by gaps in the ligamentum flavum that may confuse epidural needle placement; cause Quincke needle deformation if the vertebral bone is hit, expanding the dural sac hole and leading to cerebrospinal fluid (CSF) leakage and post-dural puncture headache; and variability in CSF volume, altering intrathecal drug dilutio...
Article
Introduction We hypothesize that the sciatic nerve in the subgluteal space has a specific behavior during internal and external coxofemoral rotation and during isometric contraction of the internal and external rotator muscles of the hip. Materials and Methods In 58 healthy volunteers, sciatic nerve behavior was studied by ultrasound during passiv...
Article
The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and...
Article
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bon...
Article
Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space (“plane”) between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatom...
Article
Full-text available
Background There is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques. Methods We c...
Article
Resumen La artroplastia total de rodilla es una de las cirugías realizadas con más frecuencia en ortopedia. No obstante, hasta un 20% de los pacientes mostrarán persistencia del dolor después del procedimiento. El dolor posquirúrgico persistente puede ser una continuación del dolor agudo tras la cirugía o aparecer después de un período asintomático...
Article
Background Injection pressure monitoring using in-line devices is affordable and easy to implement into a regional anesthesia practice. However, solid evidence regarding their performance is lacking. We aimed to evaluate if opening injection pressure (OIP), measured with a disposable in-line pressure monitor, can prevent intraneural (subepineural)...
Article
Background: Standard analgesic strategies for total knee arthroplasty employ local infiltration analgesia. Blockade and radiofrequency ablation of the genicular nerves are effective treatments for patients with chronic pain because of knee osteoarthritis. Objective: To test the noninferiority of the analgesic effect of genicular nerves block in...
Article
Full-text available
Introduction Cervical erector spinae plane block (ESPB) provides postoperative pain relief when administered at the level of first thoracic costotransverse junction (CTJ) for surgeries on the proximal shoulder and cervical spine. We propose to describe the spread of 20 ml radiocontrast - dye solution administered at this level from caudad to cephal...
Article
Full-text available
Perioperative pulmonary aspiration of gastric content is a serious complication. Fasting guidelines try to ensure an empty stomach before intervention. Certain medications or pathologies may cause delayed gastric emptying. Bedside ultrasonography is a useful tool when gastric content status is unclear or in emergency situations where fasting is not...
Article
Background and objectives The paraneural sheath is a multilayered network of collagen fibers that surround the brachial plexus. Currently, there are no sonographic data on the paraneural sheath of the brachial plexus, which this study aimed to evaluate. Methods Ultrasound imaging datasets of 100 patients who received a costoclavicular brachial ple...
Chapter
Few studies have evaluated the microanatomy of the nerves of the lower limb. Herein, gross axial anatomical sections are paired with histological sections. Such data might be useful to those studying these nerves are treating patients with pathology of these areas.
Chapter
High-resolution, light-microscopic images were obtained from cross-sections of sciatic nerves from fresh, cryopreserved, unbalmed, adult rat, rabbit, pig, sheep, dog, and human cadavers at their bifurcation. The microanatomical characteristics are presented herein.
Article
The popliteal sciatic nerve block is routinely used for anesthesia and analgesia during foot and ankle surgery. This article reviews our current understanding of the anatomy of the sciatic nerve and discusses how fascial tissue layers associated with the nerve may affect block outcomes . The anatomy of the sciatic nerve is more complex than previou...
Article
Full-text available
Purpose: High doses of local anesthetic administered intra-articularly and peri-articularly during local infiltration analgesia (LIA) for total knee arthroplasty (TKA) may have potential effects on patient hemodynamics. The aim of this study was to know if hemodynamic changes are associated with LIA in patients undergoing TKA. Methods: In a prospec...
Article
Background and objectives Circumferential (C) spread of local anesthetic around the nerve is recommended for a successful nerve block. We tested the hypothesis that C spread produces a more complete block than non-circumferential (NC) spread. Methods We randomized 124 patients undergoing open carpal tunnel syndrome surgery to receive C or NC sprea...
Article
We propose a new approach to local anesthetic injection for the supraclavicular brachial plexus block: an intertruncal approach by which local anesthetic is deposited in the two adipose tissue planes between the upper and middle and the middle and lower trunks. We present sonographic and microscopic images to illustrate the relevant anatomy. This a...
Article
Background and objectives We assume that intrafascicular spread of a solution can only occur if a large enough portion of the distal needle orifice is placed inside the fascicle. Our aim is to present and evaluate a mathematical model that can calculate the theoretical vulnerability of fascicles, analyzing the degree of occupancy of the needle orif...
Article
Introduction Thoracic erector spinae plane block is now performed in many different surgical procedures, including lumbar spinal fusion. We evaluated the analgesic effect of lumbar ESP performed at L4 after lumbar spinal fusion surgery. Methods and case series Eight patients scheduled for lumbar spinal fusion were included in the case series. Erec...
Conference Paper
Background and aims Axillary plexus blockade is a common technique in clinical practice with the pattern of structures around the artery well known. Historically, the proper response for radial nerve stimulation was only considered the extension of the hand and wrist. Methods 25 axillary blockades assessed by ultrasound and neurostimulation; the p...
Conference Paper
Background and aims Intrafascicular injection of a local anesthetic, its toxicity, and direct needle trauma to nerve tissue are generally considered the primary reasons for nerve injury after intraneural injection. We hypothesize that the only way that the local anesthetic can enter the fascicle is if at least 80% of the distal needle orifice is in...
Conference Paper
Background and aims Sciatic nerve block (SNB) is the standard for foot surgery, providing good anaesthesia and long duration of analgesia. However, the proximal sciatic block results in a motor blockage of the ankle, making walking impossible in the early postoperative period. This study was designed to assess the feasibility of a specific block of...
Article
Resumen Introducción El bloqueo en el plano del erector espinal (erector spinae plane [ESP]) a nivel torácico se ha introducido cómo método analgésico postoperatorio. Sin embargo, a pesar de que su empleo a nivel lumbar ha sido publicada, su distribución y su mecanismo de acción no han sido esclarecidos. Nos propusimos describir la técnica de punc...
Article
Introduction Thoracic erector spinae plane (ESP) block is now used for postoperative analgesia. However, although reports of lumbar ESP have been published, the anesthetic spread and mechanism of action of this technique remains unclear. We describe the lumbar ESP block technique and evaluate the spread of 20 ml of solution administered at the leve...
Article
Introduction High-resolution ultrasound (HRU) allows one to identify small nerves, but in the clinical setting, intercostobrachial nerve (ICBN) and medial brachial cutaneous nerve (MBCN) are not identified with conventional portable ultrasound (CPU) devices. The aim of this study is to identify both nerves and describe their relation with specific...
Article
Purpose: The erector spinae plane (ESP) block is an interfascial analgesic technique first described as an alternative for pain control at the thoracic level. The objective of this observational study was to determine the anatomical spread of dye following a T7 ESP block in a cadaveric model. Methods: An ultrasound-guided ESP block was performed...
Article
Introduction: Axillary plexus blockade is a common technique in clinical practice with a well-known pattern of structures around the brachial artery. Historically, the only proper response to radial nerve stimulation was considered to be extension of the hand and wrist. Materials and methods: Twenty-five axillary blockades were assessed by ultra...
Article
Introduction: The epineurium has been accepted as the outer anatomical barrier between the extraneural and intraneural compartments. Our objective was to characterize the microanatomy of the layers surrounding nerves using different tissue-specific staining methods. Materials and methods: Two hundred forty-two cross-sections of human sciatic and...
Article
Purpose of review: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. Recent findings: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fasc...
Article
Resumen Introducción El bloqueo en el plano del erector espinal (erector spinae plane [ESP]) a nivel torácico se ha desarrollado en los últimos años en multitud de procedimientos quirúrgicos, incluido los pacientes tratados mediante artrodesis lumbar. Nos propusimos evaluar el efecto analgésico del ESP realizado a nivel lumbar L4 en el postoperato...
Article
Background and objectives Ipsilateral phrenic nerve palsy (PNP) is an undesirable side of conventional approaches to interscalene brachial plexus blocks. The purpose of this study was to demonstrate whether or not the phrenic nerve can be spared by dye when injected at the division of the upper trunk of the brachial plexus. Methods Under ultrasoun...
Article
Background: There is confusion regarding the spread of intraneurally injected local anesthetic agents during regional anesthesia. The aim of this research was to deliberately inject a marker that does not leave the neural compartment into which it is injected, and then to study the longitudinal and circumferential spread and possible pathways of i...
Article
Full-text available
Introduction Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. Patients and methods A randomised, contro...
Article
Introduction To recognise the relationship between the needle tip and the median nerve during peripheral nerve block is of interest to avoid neural damage. However, signs of intraneural injection are not clearly established. The aim of this study was to define the changes observed in the peripheral nerve after the intraneural or perineural administ...
Article
Resumen Introducción Conocer la relación entre la aguja y el nervio durante el bloqueo de nervio periférico es de interés para evitar el daño neural; sin embargo, los signos de inyección intraneural no se hallan claramente establecidos. Nos propusimos determinar los cambios observados en el nervio periférico tras inyectar 1 ml de solución en dispo...
Article
Our objective was to define the positions of the nerves around the brachial artery and, secondarily, to assess the risk of intraneural injection during dual guided axillary block. Sixty ultrasound‐guided axillary blocks were performed. The locations of the musculocutaneous, median, ulnar, and radial nerves relative to the brachial artery were deter...
Article
Background Most of the works on ultrasound airway anatomy are limited to a morphological description. A study was conducted in order to provide an objective normal range of measurements. Materials and methods Observational study to describe the ultrasound characteristics of the upper airway in adults without clinical difficult airway criteria, com...
Article
Full-text available
Introduction Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. Patients and methods A randomised, contro...
Article
The fascia iliaca compartment is the compartment confined by the fascia iliaca (FI) and a muscular layer formed by the iliac- and psoas muscle. This compartment creates a virtual tunnel that contains the femoral nerve (FN), the obturator nerve (ON), and the lateral femoral cutaneous nerve (LFCN) of the lumbar plexus. In this pilot study, we aimed t...
Article
Introduction: Ambulatory surgery is associated with lower costs, but there is lack of evidence of the safety for ambulatory vascular access surgery. The objective of this study is to substantiate the safety and effectiveness of performing vascular access surgery in an ambulatory setting. Methods: A review of our prospectively maintained database...
Article
Recent anatomical discoveries indicate the importance of identifying membranes and compartments surrounding peripheral nerves into which local anesthetic agents can be injected and continuous nerve block catheters placed during regional anesthetic procedures. However, current markers used in anatomical studies have multiple drawbacks, specifically...
Article
Background: Most of the works on ultrasound airway anatomy are limited to a morphological description. A study was conducted in order to provide an objective normal range of measurements. Materials and methods: Observational study to describe the ultrasound characteristics of the upper airway in adults without clinical difficult airway criteria,...
Article
Background and objective Analgesia in ambulatory surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included. Patients and methods An observational study, physical status ASA I–II, underwent ambulato...
Article
Background and objective: Analgesia in Ambulatory Surgery (AS) needs to evolve in parallel with surgical complexity. We designed a study to try to improve analgesia in painful surgery using an intravenous elastomeric pump. As a novelty, methadone was included. Patients and methods: An observational study, physical status ASA I-II, underwent ambu...
Article
Background and objectives: Various animal models have historically been used to study iatrogenic nerve injury during performance of conduction nerve blocks. Our aims were to compare the microstructures of nerves in commonly used species to those of humans and to explore the validity of the extrapolating these findings to humans. Methods: High-re...
Article
Objective: To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space. Materials and methods: Sonographic examination (high-resolution ultrasound machine at 5.0-14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were...
Article
Introduction Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis...
Article
Introduction: Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosi...
Article
Full-text available
Clavicle fractures correspond to 35% of traumatic fractures of the shoulder girdle. Regional anaesthesia has shown better analgesic results than systemic treatment for perioperative management. Innervation of the clavicle is complex, at present its knowledge raises controversy. The lateral pectoral nerve through the innervating musculature predomin...
Article
Introduction Total knee arthroplasty (TKA) is an operation with moderate to severe postoperative pain. The Fast-Track models employ local infiltration techniques with anaesthetics at high volumes (100–150 ml). We proposed a genicular nerve block with low volume of local anaesthetic. The aim of our study is to evaluate the periarticular distribution...
Article
Full-text available
Introduction Supraclavicular block is usually performed using a lateral to medial approach, although a medial to lateral approach is also feasible. Block onset may be evaluated through the sympathetic effect associated with the sensitive and motor blockade. Objective To describe the ultrasound-guided supraclavicular block using a medial approach,...
Article
Full-text available
Resumen Introducción El bloqueo supraclavicular habitualmente se realiza mediante abordaje lateral a medial, si bien puede realizarse de medial a lateral y su instauración puede evaluarse por el efecto simpático asociado al bloqueo sensitivo y motor. Objetivo Describir el bloqueo supraclavicular ecoguiado por abordaje medial evaluando la instaura...
Article
Full-text available
Introduction: Total knee arthroplasty (TKA) is an operation with moderate to severe postoperative pain. The Fast-Track models employ local infiltration techniques with anaesthetics at high volumes (100-150ml). We proposed a genicular nerve block with low volume of local anaesthetic. The aim of our study is to evaluate the periarticular distributio...
Article
Full-text available
Clavicle fractures correspond to 35% of traumatic fractures of the shoulder girdle. Regional anaesthesia has shown better analgesic results than systemic treatment for perioperative management. Innervation of the clavicle is complex, at present its knowledge raises controversy. The lateral pectoral nerve through the innervating musculature predomin...
Article
Introduction Regional anaesthesia is commonly preferred for arteriovenous fistula (AVF) creation. Previous studies suggest a shorter block duration in patients with chronic renal failure, maybe because of the changes in regional blood flow. The aim of our study was to evaluate the duration of the axillary block with 1.5% mepivacaine in patients wit...
Article
Introduction Ultrasound-guided infraclavicular block in the costoclavicular space located between the clavicle and the first rib, reaches the secondary trunks when they are clustered together and lateral to the axillary artery. This block is most often performed through a lateral approach, the difficulty being finding the coracoid process an obstac...
Article
Background and objectives: This study aimed to describe in detail the relevant sonoanatomy, technique, and block dynamics of an ultrasound-guided costoclavicular brachial plexus block (BPB). Methods: Thirty patients scheduled for hand or forearm surgery under a BPB underwent transverse ultrasound imaging of the medial infraclavicular fossa to id...
Article
Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a...