Blocking around the transversalis fascia: behind the scene

The transversalis fascia plane and the quadratus lomborum blocks target the branches of T12-L1 nerves and provide analgesia in patients undergoing surgery involving the corresponding dermatomes. The transversalis fascia is believed to contribute to determine the spread of local anesthetic in such blocks. Nonetheless, the anatomy of this fascia and its possible role in these blocks still have to be precisely defined

Continuous wound infusion and local infiltration analgesia for postoperative pain and rehabilitation after total hip arthroplasty

BACKGROUND: Total hip arthroplasty is one of the most common procedures in orthopaedic surgery. We hypothesized that local infiltration of analgesia and continuous wound infusion of anaesthetics in the first 72 h after surgery could provide more effective postoperative analgesia with better rehabilitation. METHODS: A double-blind, randomized, controlled study was conducted with 96 patients who underwent total hip arthroplasty. The patients were randomized to receive either a local infiltration analgesia and continuous wound infusion of anaesthetics or a local infiltration analgesia and continuous wound infusion of saline solution. The patients in both groups received subarachnoid anaesthesia and a local infiltration analgesia. A multihole catheter was placed next to the implant and connected to an electronic pump containing a 300 ml solution of 0.2% levobupivacaine (experimental group) or saline (control group). RESULTS: A total of 96 consecutive patients were enrolled and randomized. Of these, 48 patients received local infiltration analgesia and continuous wound infusion of local anaesthetics, and the remainder received local infiltration analgesia and continuous wound infusion of saline solution. The analysis showed a significant main effect of treatment on the postoperative incident of pain [Ftreatment (1,93)=22.62, p=0.000] and on resting pain during the post-surgery follow-up [Ftreatment (1, 93)=15.62, p=0.0002]. The pain scores during the rehabilitation period were significantly less in the experimental group. Analgesic consumption was less in the experimental group. CONCLUSIONS: The addition of continuous wound infusion of anaesthetics to local infiltration analgesia provided an extended analgesic effect associated with good rehabilitation performance