“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block

“…[4][5][6][7] Despite the popularity of the block, its mechanism of action and how the local anesthetic (LA) injectate spreads is unclear. 8 Thus far, five cadaveric studies examining the mechanism of ESP block have been published, and the evidence on the spread to the intercostal or paravertebral spaces has been conflicting. [9][10][11][12][13] To better characterize LA spread of the ESP block, contrast injection assessed by conventional radiography or magnetic resonance imaging (MRI) and corresponding clinical evaluation in live subjects may offer advantages.…”

“…[9][10][11][12][13] To better characterize LA spread of the ESP block, contrast injection assessed by conventional radiography or magnetic resonance imaging (MRI) and corresponding clinical evaluation in live subjects may offer advantages. 8,14 Therefore, the purpose of this in vivo prospective study in a cohort of patients with chronic pelvic pain was to examine the pattern of LA spread using MRI one hour following the ESP block. We also correlated the sensory blockade and pain outcome with the MRI findings of injectate spread.…”

“…MRI was performed one hour after the block. Result The injectate spread into the intercostal space and neural foramina in all six patients, but the extent of cephalocaudal spread was variable, with a median [interquartile range] spread of 9 [5][6][7][8][9][10][11] and 3 [2][3][4][5][6] levels for the intercostal space and neural foramina, respectively. The injectate also spread extensively within the erector spinae muscles.…”

Transversus Thoracic Muscle Plane Block for Analgesia After Pediatric Cardiac Surgery

“…4,5 Introduction of ultrasonography into regional anesthesia practice paved the way for less-invasive techniques, most recently with the increased use of interfascial plane blocks. 6 These blocks drew attention in cardiac procedures because they are relatively safe and simple and bear the advantage of proximity to the surgical field. 7 Ultrasound-guided transversus thoracic muscle plane block (TTPB) is a newly developed technique that was defined by Ueshima in 2015.…”

Pectointercostal Fascial Block (PIFB) as a Novel Technique for Postoperative Pain Management in Patients Undergoing Cardiac Surgery

“…Fascial plane block is considered a "minimally invasive" regional technique that is qualitatively equivalent to neuraxial blocks. 11 PIFB is considered a component of thoracic fascial plane blocks, including transverse thoracic block, PECS block, and parasternal block. 12 Other interfascial plane block techniques explained recently are ESP block and serratus anterior plane block.…”