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.

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-anddown sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the midthigh six hours postoperatively. Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness

Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches

Interfascial plane blocks and associated nomenclature are currently popular topics in the field of anesthesia. While several novel plane blocks have been described, cadaveric studies on the spread of novel blocks are important for determining appropriate applications [1]. Recently, Tulgar et al. [2] defined the thoracoabdominal nerve block using a perichondral approach (TAPA). They reported that local anesthetic (LA) administered on the upper and lower aspect of the 9th through the 10th costal cartilages would block both the anterior and lateral cutaneous branches, thus providing abdominal analgesia. After describing the TAPA, the authors also redefined the approach, naming it the modified TAPA (M-TAPA). They reported that administering LA only to the lower surface of the costal cartilage would provide successful analgesia similar to that provided by the TAPA [3]. In the literature, there are some case reports and observational studies on the TAPA and M-TAPA [2,3]; however, to the best of our knowledge, no reliable cadaveric investigation has demonstrated the spread of these blocks. Therefore, in this cadaveric investigation, we aimed to evaluate the areas of spread associated with the TAPA and M-TAPA. This study was approved by the Istanbul Medipol University Ethics and Research Committee (Decision No. 36, 06.01.2022)

Clinical Experience for Modified Thoracoabdominal Nerve Block Through Perichondrial Approach (M-TAPA) in Five Patients. Dermatomal Evaluation and Application of Different Volumes: A Case Series and Review of Literature

Thoracoabdominal nerves block through perichondrial approach (TAPA) is a novel block and provides abdominal analgesia. TAPA block targets the both anterior and the lateral branches of the thoracoabdominal nerves. Modified-TAPA (M-TAPA) was defined due to the need for blocking certain dermatomes depending on the surgical incision sites. In the literature, the knowledge about the efficiency and dermatomal coverage of M-TAPA is limited. In this case series, we want to report our experiences with this issue

Erector Spinae Plane Block and Chronic Pain: An Updated Review and Possible Future Directions

: Chronic pain is a common, pervasive, and often disabling medical condition that affects millions of people worldwide. According to the Global Burden of Disease survey, painful chronic conditions are causing the largest numbers of years lived with disability worldwide. In America, more than one in five adults experiences chronic pain. Erector spinae plane block is a novel regional anesthesia technique used to provide analgesia with multiple possible uses and a relatively low learning curve and complication rate. Here, we review the erector spinae plane block rationale, mechanism of action and possible complications, and discuss its potential use for chronic pain with possible future directions for research

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

Database studies and hemogram derivatives in perioperative medicine research: Does it mean taking shortcuts in the scientific journey?

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Where does the praise for artificial intelligence come to an end? Tolerance for anything is not boundless

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