Rhomboid Intercostal and Subserratus Plane Block

Elsharkawy, Hesham; Maniker, Robert B.; Bolash, Robert; Kalasbail, Prathima; Drake, Richard L.; Elkassabany, Nabil

doi:10.1097/aap.0000000000000824

Cited by 55 publications

(83 citation statements)

References 21 publications

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“…This fascia is continuous throughout the cervical, thoracic and lumbar spine,18 19 which facilitates injectate spread 6. This study provides evidence that the fascial plane in the thoracic area deep to ES muscles, the target for ESP block, is in continuity caudally with the MTLF in the lumbar region posterior to the QL muscle, medially superficial to the laminae for the retrolaminar block and laterally with the tissue plane deep to the rhomboid and serratus anterior muscles for the rhomboid intercostal and subserratus block 20. With current nomenclature, injection at any of these points along the same tissue plane may be considered different techniques based on needle insertion site despite continuity of planes.…”

Section: Discussionmentioning

confidence: 69%

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Elsharkawy

Bajracharya

El‐Boghdadly

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesBoth posterior quadratus lumborum (QL) and erector spinae plane (ESP) blocks have been described as new truncal interfascial plane blocks. Distribution of injectate is influenced by fascial anatomy; therefore, different injection sites may produce similar spread. This anatomic study was designed to test the hypothesis that a posteromedial QL block at L2 level will more closely resemble a low thoracic ESP block when compared with the posterolateral approach at L2 level.MethodsLeft-sided ESP blocks were performed in six cadavers at T10–11. Three of these cadavers received right-sided posteromedial QL block at L2, while the other three received right-sided posterolateral QL block at L2. All injections were composed of 20 mL methylcellulose 0.5 % mixed with India ink and 10 mL of Omnipaque (Iohexol) 240 mg/mL. CT 24 hours after injection and cadaver dissection were used to evaluate injectate spread.ResultsCephalocaudal spread of injectate by CT and cadaveric dissection was highly correlated (r=0.85 [95% CI 0.51 to 0.95]). Cadaver dissection showed ESP injectate spread deep to the muscle (mean [SD]) 11.7 (2.3) levels compared with 7.3 (1.2) levels for posterolateral QL and 9.7 (1.5) for posteromedial QL (p=0.04 overall, with a statistically significant pairwise difference between ESP and posterolateral QL only). The subcostal nerve and dorsal rami were commonly involved in most blocks, but the paravertebral space and ventral rami had inconsistent involvement. The lumbocostal ligament limited cranial spread from the posterlateral QL block approach.ConclusionsThe posteromedial QL block at L2 produces more cranial spread beyond the lumbocostal ligament than the posterolateral QL block, and this spread is comparable with a low thoracic ESP block. Both posterior QL and ESP blocks show unreliable spread of injectate to the paravertebral space and ventral rami, but the dorsal rami were frequently covered.

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Section: Discussionmentioning

confidence: 69%

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Elsharkawy

Bajracharya

El‐Boghdadly

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

Self Cite

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“…Initially, we identified 368 articles, out of which 233 articles were excluded because they were duplicates; however, 4 additional articles were identified from a different source and included in the review. Of the 139 remaining articles, 2 were excluded after reading the abstracts [126,127] which revealed that they were not related to ESP blocks. One was a review of adjuvant nerve blocks, and the other was an anatomical study of a different type of block.…”

Section: Methodsmentioning

confidence: 99%

The erector spinae plane block: a narrative review

Kot

Rodríguez

Granell

et al. 2019

Korean J Anesthesiol

208

146

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Regional anesthesia and pain management have experienced advances in recent years, especially with the advent of fascial plane blocks. The erector spinae plane block is one of the newest techniques to be described. In the past two years, publications referring to ESP block have increased significantly. The objective of this review is to analyze the articles about ESP block that have been published to date. We performed a search in the main databases and identified 368 articles. After a selection of the relevant articles, 125 studies were found eligible and were included in the review. The ESP block is performed by depositing the local anesthetic in the fascial plane, deeper than the erector spinae muscle at the tip of the transverse process of the vertebra. Many cases of its use have been described with satisfactory results in the treatment of both acute pain and chronic pain. The applicability of the technique covers many clinical scenarios. Of the 98 case reports reviewed, 12 and 87 articles, respectively described the technique as a treatment for chronic pain and acute pain. The single-shot was the most frequently used technique. As described in the articles published to date, the technique is easy to perform and has a low rate of complications. However, despite the effectiveness of the technique, further studies are necessary to obtain more evidence of its actions.

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“…This ''continuous plane'' has been shown by the newly described ''rhomboid intercostal and subserratus plane'' block. 4 In cadavers, the presence of rib fractures facilitated a deeper and more posterior spread of SP injections when compared with a hemithorax with intact ribs.…”

mentioning

confidence: 98%

Cadaveric findings of the effect of rib fractures on spread of serratus plane injections

Johnston

Black

O’Halloran

et al. 2019

Can J Anesth/J Can Anesth

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Rhomboid Intercostal and Subserratus Plane Block

Abstract: Our preliminary cadaveric and clinical data suggest that RISS block anesthetizes the lateral cutaneous branches of the thoracic intercostal nerves and can be used in multiple clinical settings for chest wall and upper abdominal analgesia.

Cited by 55 publications

References 21 publications

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study

The erector spinae plane block: a narrative review

Cadaveric findings of the effect of rib fractures on spread of serratus plane injections

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