Serratus posterior superior intercostal plane block for breast surgery: A report of three cases, novel block and new indication

Breast surgery is a common surgical procedure in the world. Since it affects the postoperative recovery and mobilization, pain after breast surgery is an important issue.1 Several regional techniques such as interpectoral/ pectoserratus blocks (PECS I/II), erector spinae plane block (ESPB), and rhomboid intercostal plane block (RIB) are used for pain relief after breast surgery. PECS I-II blocks most commonly used techniques for breast analgesia.2 However, they are closed to the surgical area, and the local anesthetic distribution may be affected by the surgical incision of the pectoral muscles. ESPB may be performed from the cervical to the sacral vertebrae. The clinical, cadaveric, and radiological results of ESPB are inconsistent.3 RIB provides focused hemithoracic analgesia; however, RIB fails to cover the cranial aspect of the T2 dermatome.

Serratus posterior superior intercostal plane block: A technical report on the description of a novel periparavertebral block for thoracic pain

Background and objectiveWe report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block.DesignA cadaveric evaluation along with a retrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. InterventionsBilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients.Main resultsAnatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax.ConclusionOur cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia

Ultrasound-guided rhomboid intercostal block effectively manages myofascial pain

We have read with great interest the article on rhomboid intercostal and subserratusblock by Elsharkawy et al. [1]. They have reported that rhomboid intercostal and sub-serratus block helps effectively manage pain in patients after major abdominal surgeries.Herein, we would like to report that rhomboid intercostal block (RIB) may also provideeffective pain relief in myofascial pain syndrome (MPS). MPS is a chronic disease that affects 21–30% of the population [2]. It originates in the painful trigger points of skeletalmuscle, and patients suffer moderate to severe pain. Medications and ultrasound-guidedinjections at the trigger points may be used to treat MPS

Long-lasting pain relief with interfascial plane blocks: Key role of opening interfascial adhesions

Dear Editor, We have read with great interest and carefully the correspondence by Piraccini et al. [1] as an answer to our case who had myofascial pain syndrome (MPS) and was performed rhomboid intercostal block (RIB) in our clinic [2]. We thank the authors for their valuable comments and opinions. Their article's contribution may be a new way for both diagnosis and treatment of MPS due to fascial adhesion. Here, we want to share our patient’s long-lasting pain relief results to provide additional information in this field

Bilateral Pneumothorax during Apnea Test: A Case Report and Literature Review

Brain death is characterized by irreversible loss of all brain functions and it is defined as a clinical condition where intracranial circulation stops. Apnea test is one of the tests which is used in the clinical diagnosis of brain death, absence of brain stem reflexes, and as a complement to absence of motor response to painful stimulants. Apnea test is a test which has a high complication rate. Complications such as hypoxia, hypotension, acidosis, cardiac arrhythmia, asystole, pneumothorax, pneumomediastinum and pneumoperitoneum may develop during an apnea test. In this case report, a patient with biletarel pneumothorax due to air trapping because of an oxygen cannula blocking the airway

Ultrasound-guided combined interscalene and superficial cervical plexus blocks for anesthesia management during clavicle fracture surgery

To the Editor, Fractures of the clavicle constitute 2.6–4% of all fractures in adult patients. The most frequent injury mechanism is a direct trauma on the shoulder. These fractures are mainly treated surgically (Kihlstrom et al. 2017). The cervical and brachial plexus innervate the clavicular region (Tran et al. 2013). Thus, interscalene brachial plexus block (IBPB) and superficial cervical plexus block (SCPB) may be used for pain management following clavicular surgery. Herein, we aimed to report our ultrasound (US)-guided IBPB and SCPB combination experiences for anesthetic management during clavicular surgery

Is rib an alternative landmark for ESPB instead of a transverse process? A little more lateral injection, lateral to the fascial plane

Dear Editor,We have read with great interest the article by Mislovic et al.1 The authors used a new terminology named Lateral Erector Spinae Plane Block (LESPB) with this manuscript. They reported that due to the anatomical variation caused by previous spinal surgery, it is impossible to visualize the transverse process (TP). So, the authors decided to move the probe laterally until it shows the thoracic rib and deposits the local anesthetic after contacting the rib instead of the TP. In addition, they named this block LESPB

Lumbar erector spinae plane block as a main anesthetic method for hip surgery in high risk elderly patients: initial experience with a magnetic resonance imaging

Objective: Since initial description by Forero for thoracic region, ultrasound guided erector spinae plane (ESP) block has experienced several surgeries for postoperative pain management, chronic pain or surgical anesthesia. Although ESP block has been reported to provide effective analgesia in the thoracic region, its effect in lumbar region still unclear. In this study we aimed to showed our successful experience with lumbar ESP block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation.Materials and Methods: In this observational study high risk elderly fifteen patients received lumbar ESP block as a main anesthetic technique with mild propofol sedation. 40 mL of local anesthetic mixture (20 mL bupivacaine 0.5%, 10 mL lidocaine 2%, and 10 mL normal saline) was administered between the erector spinae muscles and transverse process at the level of the 4th lumbar vertebra. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block.Results: All patients' surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. All patients' pain scores were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle.Conclusion: Lumbar ESP block when combined with mild sedoanalgesia provides adequate and safe anesthesia in high risk elderly patients undergoing hip surgery

Deep supraspinatus muscle plane block: Is it just a new description of an old technique?

To the Editor, We have read with interest the reply to Kose et al. by Teles et al. [1]. The authors commented on the deep supraspinatus muscle plane block (DSMPB) performed by Kose et al. in terms of nomenclature being used and the technique's novelty. Thanks to the rapidly growing use of ultrasound (US) during daily anesthesia practice, definitions and names of novel interfascial plane blocks have continued to evolve. However, the new techniques of the current blocks may end up being defined as new blocks. At this critical point, we should be careful about what nomenclature we use for these new techniques