SummaryThe serratus anterior plane block has been described for analgesia of the hemithorax. This study was conducted to determine the spread of injectate and investigate the anatomical basis of the block. Ultrasound-guided serratus anterior plane block was performed on six soft-fix embalmed cadavers. All cadavers received bilateral injections, on one side performed with 20 ml latex and on the other with 20 ml methylene blue. Subsequent dissection explored the extent of spread and nerve involvement. Photographs were taken throughout dissection. The intercostal nerves were involved on three occasions with dye, but not with latex. The lateral cutaneous branches of the intercostal nerve contained dye and latex on all occasions. The serratus plane block appears to be mediated through blockade of the lateral cutaneous branches of the intercostal nerves. Anatomically, serratus plane block does not appear to be equivalent to paravertebral block for rib fracture analgesia.
There is no universally agreed set of anatomical structures that must be
identified on ultrasound for the performance of ultrasound-guided regional
anesthesia (UGRA) techniques. This study aimed to produce standardized
recommendations for core (minimum) structures to identify during seven basic
blocks. An international consensus was sought through a modified Delphi
process. A long-list of anatomical structures was refined through serial
review by key opinion leaders in UGRA. All rounds were conducted remotely
and anonymously to facilitate equal contribution of each participant. Blocks
were considered twice in each round: for “orientation scanning” (the dynamic
process of acquiring the final view) and for the “block view” (which
visualizes the block site and is maintained for needle insertion/injection).
Strong recommendations for inclusion were made if ≥75% of participants rated
a structure as “definitely include” in any round. Weak recommendations were
made if >50% of participants rated a structure as “definitely include” or
“probably include” for all rounds (but the criterion for “strong
recommendation” was never met). Thirty-six participants (94.7%) completed
all rounds. 128 structures were reviewed; a “strong recommendation” is made
for 35 structures on orientation scanning and 28 for the block view. A “weak
recommendation” is made for 36 and 20 structures, respectively. This study
provides recommendations on the core (minimum) set of anatomical structures
to identify during ultrasound scanning for seven basic blocks in UGRA. They
are intended to support consistent practice, empower non-experts using basic
UGRA techniques, and standardize teaching and research.
Percutaneous nephrostolithotomy in obese patients yields a stone-free rate that is comparable to that achieved in an unselected patient population. The complication rate, transfusion rate and hospital stay are also similar. Modifications to standard technique and instrumentation are sometimes necessary to perform percutaneous nephrostolithotomy in this group of patients.
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