Background: External oblique intercostal block (EOIB) is effective in relieving pain in the T6 to T10 dermatomes; however, there is limited evidence comparing EOIB with conventional regional anesthesia. In this randomized controlled trial, it was hypothesized that EOIB would provide more effective analgesia than wound infiltration (WI) in laparoscopic gastrectomy. Methods: Thirty-two patients (aged 20–85 years) with American Society of Anesthesiologists Performance Status of 1 to 2, scheduled for laparoscopic gastrectomy, were randomly divided into EOIB and WI groups. Both procedures were performed using 40 mL of 0.25% levobupivacaine. The primary outcome was the numerical rating scale (NRS) score 12 h postoperatively. Secondary outcomes were NRS at 2, 24, and 48 h postoperatively, variation in quality of recovery-15 score on postoperative days 1 and 2 from preoperative baseline, postoperative fentanyl consumption, and variation in World Health Organization Disability Assessment Scale 2.0 scores between baseline and 3 months postoperatively. Plasma concentrations of levobupivacaine and pinprick sensation in the T4–11 dermatomes post-EOIB were evaluated to determine the exploratory endpoints. Results: There were no differences in the NRS scores 12 h postoperatively at rest and during movement between the EOIB and WI groups (mean standard deviation 1.3 [1.1] vs. 1.5 [1.4] and 3.1 [1.6] vs. 3.8 [1.7], respectively). Secondary outcomes did not differ significantly between the groups. The time to peak plasma concentration of levobupivacaine following EOIB was 45 min. Conclusions: No significant differences in NRS scores were observed between the analgesic effects of EOIB and WI at 12 h postoperatively.

Background: Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space.Case: We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0–10) at rest were maintained below 4.Conclusions: The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.

Terest in our case report [1]. We want to reply because we believe that organizing the concept of the intertransverse process block (ITPB) and discussing it in Anesthesia and Pain Medicine will help readers better understand the process. In determining the nomenclature of regional anesthesia, the ITPB concept encompasses the multiple injection costotransverse block, the subtransverse process interligamentary plane block, the costotransverse foramen block (CTFB), and the midpoint transverse process to pleura block (MTPB) [2]. Please note that we performed a 'costotransverse foramen block' in case 1 [3], which is a faithful reproduction of the report by Shibata et al., and we did not perform a 'multiple injection costotransverse block. ' In fact, there was a discussion between Dr. Shibata's group and Dr. Nielson's group regarding with the needle direction [4]; please refer to that as well. We performed CTFB in support of the opinion of Dr. Shibata et al that caudal to cephalad needle direction minimizes the risk of neurovascular injury. Therefore, we believe that the needle direction was correct. We believe this point was caused by the confusion of nerve blocks with similar names and concepts, and that it is clear that procedures of ITPB need to be standardized. Another point of interest in his letter was the representation of CTFB and MTPB as interfascial plane blocks. ITPB targets the tissue complex posterior to the superior costotransverse ligament (SCTL) [5] and is considered distinctly different from blocks that target the fascial plane, such as the erector spinae plane block. This 'intertransverse tissue complex' comprises the intertransverse ligament, fatty tissue, the intertransverse and lavatores costarum muscles, and the SCTL. Different from interfascial plane blocks, the feature of achieving analgesic efficacy by administration of local anesthetics into tissue complexes closer to the pathway to the paravertebral space is

Background and Aims Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) was first described as a peripheral nerve block by Tulgar in 2019, which provides an analgesic effective range in Th7–11 with a single puncture per side₁. The efficacy and effective duration of the M-TAPA has been reported in several case reports; however its effects require further examination. Methods With an IRB approval (No.2700) and registration (UMIN Clinical Trials Registry: UMIN000041137), 10 adult female patients scheduled for an open radical hysterectomy with vertical incision or laparotomy with a midline incision from under the xiphoid process to the symphysis pubis were enrolled. The primary outcome was the number of anesthetized dermatomes at 2 and 24 h postoperatively. Secondary outcomes included the numerical rating scale scores and the total amount of fentanyl used. Cadaveric evaluation was performed to assess the spread of the dye. Results Patient characteristics are shown in table 1. The median number (interquartile range) of anesthetized dermatomes at 2 and 24 h postoperatively were 6 (5–7) and 6.5 (5–7) in the anterior cutaneous branch area, and 5 (4–7) and 7 (5–7) in the lateral cutaneous branch area, respectively. (Figure 1) There was an 85% chance of simultaneously acquiring the Th8–Th11 analgesic area including completely blocking Th9–10 in the anterior cutaneous branch area. Results are presented in table 2. Cadaveric evaluation showed the spread of the dye in Th8–11. Patient characteristics Conclusions M-TAPA may provide an analgesic effect in Th8–11 in the anterior cutaneous branch area.