RESUMEN
PURPOSE: This study aimed to determine whether the administration of a modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) could result in the blockade of the lateral cutaneous branches. This study focused on a newly discovered anatomical space/plane adjacent to the M-TAPA plane, which we termed "space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess: SEDIC." METHODS: Thirteen sides of nine formalin-embalmed cadavers were macroscopically dissected to investigate the anatomical spaces related to the effects of M-TAPA. Furthermore, ten adult volunteers were administered 20 mL of 0.2% ropivacaine into the abdominal plane (corresponding to the M-TAPA plane) and the SEDIC, and a pinprick test was performed 1 h after the injection. RESULTS: Cadaver macrodissection revealed the presence of the SEDIC adjacent to the M-TAPA plane. The SEDIC was completely spatially isolated from the M-TAPA plane by the presence of costal cartilage and/or tendinous structures. In the volunteer study, the administration of local anesthetics into the SEDIC effectively blocked the lateral cutaneous branches of T8-T12, in addition to the anterior branches. CONCLUSION: Our study revealed the presence of the SEDIC adjacent to the M-TAPA plane. Administration of local anesthetics into the SEDIC, named re-modified TAPA, may have the potential to enhance the analgesic effect in the abdominal region.
RESUMEN
The costal and lateral external oblique muscle plane (EXOP) blocks anesthetize the lateral cutaneous branches, whereas the modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) anesthetizes the anterior branches of the thoracoabdominal nerves. Herein, we report two cases of successful perioperative pain management with the combination of these blocks: case 1 was a 67-year-old man who underwent open cholecystectomy and case 2 was a 38-year-old woman who underwent emergency laparoscopic surgery for strangulation ileus. Both patients were administered the costal and/or lateral EXOP blocks along with bilateral M-TAPA for perioperative analgesia. A pin-prick test performed 1 h after surgery revealed that the cutaneous sensory block covered all areas of the abdominal surgical field. Combined use of these blocks can be a new local analgesic strategy for abdominal surgery.
RESUMEN
PURPOSE: No reports have described techniques to efficiently anesthetize the lateral cutaneous branches of the entire abdomen. The aim of this study was to investigate an effective procedure for blocking the lateral cutaneous branches in the abdominal region. We sought to describe the sensory distribution of the previously described thoracoabdominal nerve block through perichondrial approach (TAPA) and the novel costal and lateral external oblique muscle plane (EXOP) blocks in healthy volunteers. METHODS: This was a proof-of-concept pilot study that comprised ten volunteers with an American Society of Anesthesiologists Physical Status I. The participants underwent modified TAPA (M-TAPA), injection 2 of TAPA (injection into the anterior aspect of the 10th costal cartilage: I2-TAPA), costal EXOP, and lateral EXOP blocks with injection of 20 mL of ropivacaine 0.2% for each block. A pinprick test was performed one hour after injection and repeated at 30-min intervals until the effect of the nerve block disappeared. RESULTS: The M-TAPA injection anesthetized the anterior branches from T6/7 to T11/12, whereas the I2-TAPA injection had no effect. Costal and lateral EXOP injections anesthetized the lateral cutaneous branches of T7-10 and T11-12, respectively. CONCLUSION: The results of this pilot study in ten healthy volunteers indicate that novel EXOP blocks involving local anesthetic injection superficial to the external oblique muscle efficiently anesthetize the lateral cutaneous branches of the thoracoabdominal nerves. Our study shows that it may be anatomically plausible for the combined use of these blocks to anesthetize the entire abdominal wall.
RéSUMé: OBJECTIF: Aucune présentation de cas n'a décrit de techniques permettant l'anesthésie efficace des branches cutanées latérales de tout l'abdomen. L'objectif de cette étude était d'évaluer une procédure efficace pour bloquer les branches cutanées latérales de la région abdominale. Nous avons cherché à décrire la distribution sensorielle du bloc nerveux thoraco-abdominal par approche périchondrale (TAPA), décrit précédemment, et des nouveaux blocs du plan musculaire oblique externe (EXOP) costal et latéral réalisés chez des volontaires sains. MéTHODE: Il s'agissait d'une étude pilote de preuve de concept qui comprenait dix volontaires avec un statut physique I selon l'American Society of Anesthesiologists. Les participants ont bénéficié d'un bloc TAPA modifié (M-TAPA), de l'injection 2 d'un bloc TAPA (injection dans l'aspect antérieur du 10e cartilage costal : I2-TAPA), d'un bloc EXOP costal et d'un bloc EXOP latéral avec injection de 20 mL de ropivacaïne 0,2 % pour chaque bloc. Un test cutané par piqûre d'épingle a été réalisé une heure après l'injection et répété à des intervalles de 30 minutes jusqu'à ce que l'effet du bloc nerveux disparaisse. RéSULTATS: L'injection de M-TAPA a anesthésié les branches antérieures de T6/7 à T11/12, tandis que l'injection d'I2-TAPA n'a eu aucun effet. Les injections costales et latérales d'EXOP ont anesthésié les branches cutanées latérales de T710 et T1112, respectivement. CONCLUSION: Les résultats de cette étude pilote chez dix volontaires sains indiquent que les nouveaux blocs EXOP avec une injection superficielle d'anesthésique local au muscle oblique externe anesthésient efficacement les branches cutanées latérales des nerfs thoraco-abdominaux. Notre étude montre qu'il peut être anatomiquement plausible de combiner ces blocs pour anesthésier toute la paroi abdominale.
Asunto(s)
Pared Abdominal , Anestésicos Locales , Músculos Abdominales/inervación , Músculos Oblicuos del Abdomen , Pared Abdominal/inervación , Voluntarios Sanos , Humanos , Proyectos Piloto , Ropivacaína , Ultrasonografía Intervencional/métodosAsunto(s)
Laminectomía/efectos adversos , Laminoplastia/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Dolor Asociado a Procedimientos Médicos/prevención & control , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Femenino , Humanos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Asociado a Procedimientos Médicos/etiología , Vértebras Torácicas/cirugía , Resultado del TratamientoAsunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Nervio Femoral/efectos de los fármacos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Anciano , Anestesia General , Anestésicos Locales/administración & dosificación , Femenino , Nervio Femoral/diagnóstico por imagen , Humanos , Osteoartritis de la Rodilla/cirugía , Dolor Postoperatorio/etiología , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
Local anesthetic injection into the medial head of the semispinalis capitis muscle can anesthetize the greater occipital nerve (GON) and third occipital nerve (TON) simultaneously (greater and third occipital nerve block: GTO block). Alternatively, inter-semispinal plane (ISP) block can anesthetize the dorsal rami of the cervical spinal nerves from C4 to T4. The GON, TON, and the dorsal rami of the inferior level cannot be blocked with a single injection. To elucidate this phenomenon from an anatomical standpoint, we performed an ISP block either alone or with a GTO block using water-based acrylic dye in three thiel-embalmed cadavers. Both dyes were clearly separated by the tendinous septum running obliquely inside the semispinalis capitis muscle (SCA). The tendinous septum of the SCA may have a relatively strong connection with the dorsal edge of the semispinalis cervicis muscle, and this structure may stem the injectate spread. Therefore, the GON and TON, running through the medial head of the SCA, and the dorsal rami of the inferior level are spatially separated by the tendinous septum, and cannot be blocked with a single injection.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Músculos Paraespinales/anatomía & histología , Cadáver , Plexo Cervical/anatomía & histología , Humanos , Inyecciones , Nervios Espinales/anatomía & histologíaAsunto(s)
Analgesia , Bloqueo Nervioso , Músculos Paraespinales , Humanos , Manejo del Dolor , Dolor de HombroAsunto(s)
Laminoplastia/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Compresión de la Médula Espinal/cirugía , Espondilosis/complicaciones , Anciano , Anestesia General , Anestésicos Locales/administración & dosificación , Vértebras Cervicales , Humanos , Masculino , Dolor Postoperatorio/etiología , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/inervación , Compresión de la Médula Espinal/etiología , Resultado del Tratamiento , Ultrasonografía IntervencionalAsunto(s)
Analgesia/métodos , Mamoplastia/efectos adversos , Mastectomía/efectos adversos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/prevención & control , Anestésicos Locales/administración & dosificación , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mamoplastia/instrumentación , Mamoplastia/métodos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/inervación , Periodo Perioperatorio , Biopsia del Ganglio Linfático Centinela/efectos adversos , Dispositivos de Expansión Tisular/efectos adversos , Resultado del Tratamiento , Ultrasonografía IntervencionalRESUMEN
We previously reported that a novel multifidus cervicis plane (MCP) block could anesthetize the dorsal rami of the cervical spinal nerves. While MCP sonoanatomy is easily detectable in most patients, it is sometimes difficult to recognize the MCP injection plane, especially in elderly patients. Thus, we proposed the inter-semispinal plane (ISP) block as an alternative for the MCP block. The aim of this study was to evaluate the utility of the ISP block by evaluating the area and duration of anesthesia, compared with that of the MCP block in eight healthy volunteers. Each participant underwent unilateral ultrasound-guided MCP block and ISP block. For each block, 20 ml of ropivacaine 0.2% was injected, and the area of anesthesia was determined using the pinprick test. The anesthetic area ranged from C4 to T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (3/8; 37.5%) in the MCP block, and from C4 to T1 (1/8; 12.5%), T2 (3/8; 37.5%), T3 (2/8; 25%), or T4 (1/8; 12.5%) in the ISP block. The mean (standard deviation) duration of sensory loss following MCP and ISP blocks was 329 (77) min and 349 (70) min, respectively. Thus, the ISP block may be a reliable alternative to the MCP block.