ABSTRACT
We investigated the distribution of injected dye after deep serratus anterior plane and superficial parasternal intercostal plane blocks in 15 Thiel embalmed cadavers. We injected 0.4 ml.kg-1 of 0.25% aqueous methylene blue solution into the deep serratus anterior and superficial parasternal intercostal planes using real-time ultrasound needle visualisation followed by posterior dissection to observe the distribution of the injected dye in the chest wall. The two blocks were performed bilaterally in 15 cadavers at the T5/T6 level, comprising 60 blocks in 30 hemithoraces in total. At dissection, the intercostal nerve territories were observed to be dyed completely from T2 to T6 in 28 of 30 hemithoraces, and extending caudal to T6 in 10 hemithoraces. Following the deep serratus anterior plane blocks in all cadavers, the dye was found to have spread to the axillae. Following the superficial parasternal intercostal plane blocks, the dye reached T7 in four cadaver dissections. We concluded that the territories innervated by the intercostal nerves (T2-T6 dermatomes) are dyed following the combination of the two blocks when performed at the T5-T6 intercostal space level. These techniques might provide an effective option for anaesthesia in breast surgery.
ABSTRACT
La cirugía de corrección de la columna es un procedimiento quirúrgico invasivo que origina daño postoperatorio severo. Reportamos 6 casos de bloqueo en el plano del músculo erector de la columna para cirugía de escoliosis. Nuestro objetivo fue aportar tratamiento efectivo para el dolor perioperatorio, y lograr estabilidad hemodinámica intraoperatoria, sin interferir en la neuromonitorización. También se destacan los retos técnicos. El escáner ecoguiado es necesario para identificar las prominencias óseas y determinar los posibles puntos de inyección múltiples. El bloqueo en el plano del músculo erector de la columna en cirugía de escoliosis es una técnica más fácil y segura, en comparación con la anestesia epidural, pudiendo utilizar cirugía de columna compleja instrumentada. Este bloqueo parece desempeñar un papel en la vía del dolor perioperatorio, complementando el régimen anestésico multimodal y no interfiriendo en los potenciales evocados en adultos. Sin embargo, el mecanismo de difusión de este bloqueo es poco conocido aún y, por tanto, debemos ser conscientes de la toxicidad del anestésico local
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity
Subject(s)
Humans , Male , Female , Child , Adolescent , Neuromuscular Blockade/methods , Anesthetics, Local/administration & dosage , Ropivacaine/administration & dosage , Scoliosis/surgery , Treatment OutcomeABSTRACT
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity.
Subject(s)
Nerve Block/methods , Pain, Postoperative/therapy , Paraspinal Muscles , Scoliosis/surgery , Adolescent , Anesthetics, Intravenous/administration & dosage , Anesthetics, Local/administration & dosage , Child , Dexmedetomidine/administration & dosage , Female , Humans , Hypnotics and Sedatives/administration & dosage , Male , Propofol/administration & dosage , Ropivacaine/administration & dosageABSTRACT
La analgesia postoperatoria efectiva después de la cesárea de urgencia es importante porque proporciona una recuperación y deambulación temprana, así como el inicio precoz de la lactancia materna. El bloqueo del plano del erector del espinal guiado por ecografía ha sido descrito originalmente por Forero et al. para proporcionar analgesia torácica. Se realizaron bloqueos del plano del erector del espinal bilaterales postoperatorios con 20ml de bupivacaína al 0,25% al nivel de T9 en una embarazada para analgesia postoperatoria tras cesárea. En esta presentación describimos cómo el bloqueo del plano del erector del espinal bilateral en el nivel T9 proporciona analgesia postoperatoria efectiva y duradera para la cirugía abdominal inferior
Effective postoperative analgesia after emergency caesarean section is important because it provides early recovery, ambulation and breast-feeding. The ultrasound-guided erector spinae plane block has been orginally described for providing thoracic analgesia at the T5 transverse process by Forero et al. We performed post-operative bilateral erector spinae plane blocks with 20ml bupivacaine 0.25% at the level of the T9 transverse process in a pregnant woman after caesarean section. In this report, we described that bilateral erector spinae plane block at T9 level provides effective and long-lasting postoperative analgesia for lower abdominal surgery
Subject(s)
Humans , Female , Young Adult , Nerve Block/methods , Spinal Nerves , Anesthesia, Conduction/methods , Cesarean Section/methods , Analgesia, Obstetrical/methods , Pain, Postoperative/drug therapy , Pain Management/methodsABSTRACT
Effective postoperative analgesia after emergency caesarean section is important because it provides early recovery, ambulation and breast-feeding. The ultrasound-guided erector spinae plane block has been orginally described for providing thoracic analgesia at the T5 transverse process by Forero et al. We performed post-operative bilateral erector spinae plane blocks with 20ml bupivacaine 0.25% at the level of the T9 transverse process in a pregnant woman after caesarean section. In this report, we described that bilateral erector spinae plane block at T9 level provides effective and long-lasting postoperative analgesia for lower abdominal surgery.
