Article: Maximum extension and regression rate of cutaneous sensory block obtained with the external oblique intercostal block or the modified thoracoabdominal nerves block through perichondrial approach in patients undergoing laparoscopic cholecystectomy - Minerva Anestesiologica 2024 November;90(11):979-88 - Minerva Medica - Journals

Background: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. Methods: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively.Results: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]).Conclusions: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Background: Open inguinal hernia repair (OIHR) surgery is a common surgical procedure, and ultrasound guided interfascial plane blocks can also be included in current approaches to postoperative multimodal analgesia regimens. This study aimed to compare the postoperative analgesic efficacy of the erector spinae plane block (ESPB) and transversalis fascia plane block (TFPB) in patients undergoing OIHR.Methods: This prospective, randomized, assessor-blinded comparative study was conducted in the postoperative recovery room and ward of a tertiary hospital. A total of 80 patients with American Society of Anesthesiologists physical status I–III were enrolled and allocated equally to either the ESPB or TFPB group. The patients received standard multimodal analgesia in addition to an ultrasound-guided ESPB or TFPB. During the first 24 h postoperatively, tramadol consumption was assessed and pain levels at rest and during movement were compared using numeric rating scale (NRS) scores at 1, 3, 6, 9, 12, 18, and 24 h postoperatively.Results: The results showed no difference in NRS scores at any time point between the groups, except for NRS at rest in the third hour. However, tramadol consumption was lower in the TFPB group than in the ESPB group overall (88 ± 75.2 vs. 131 ± 93.7 mg, respectively; P = 0.027, mean difference: −43, 95% CI [−80.82, −5.18]).Conclusions: The TFPB leads to lower tramadol requirements in the first 24 h postoperatively than the ESPB in patients undergoing OIHR.

Total knee arthroplasty (TKA) is associated with significant postoperative pain, managed with multimodal analgesia, including regional anesthesia techniques like peripheral nerve blocks. The knee joint’s innervation by both sacral and lumbar plexuses often necessitates combined blocks for effective analgesia. This study aimed to compare the effects of suprainguinal fascia iliaca block (SIFIB) and a combination of popliteal artery and posterior knee capsule injection (IPACK) with adductor canal block (ACB) on 24-hour postoperative pain scores, as well as their impact on inflammatory markers and biochemical indicators of myotoxicity. The study included patients undergoing elective unilateral primary knee arthroplasty. They were divided into 2 groups: 1 received postoperative SIFIB, and the other underwent IPACK preoperatively and ACB postoperatively. Postoperative evaluations included Numeric Rating Scale scores, morphine consumption, quadriceps muscle strength, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune inflammation score, C-reactive protein (CRP), lactate, and creatine phosphokinase (CPK) levels as a marker of myotoxicity. CPK increases of more than 5-fold were assessed for rhabdomyolysis. Pain scores at rest and with movement were comparable between groups at all time points (P > .05). Morphine consumption over 24 hours did not differ significantly (P > .05). Similarly, inflammatory markers, including NLR, PLR, systemic immune inflammation score, CRP, and lactate, showed no significant differences between groups at 12 and 24 hours (P > .05). CPK levels, evaluated as indicators of myotoxicity and rhabdomyolysis, were also similar (P > .05). Quadriceps strength, assessed as an indicator of motor loss, showed no significant differences between groups (P > .05). The analgesic efficacy, safety, and inflammatory responses of SIFIB were comparable to those of the IPACK + ACB combination. Given its technical simplicity and ability to target multiple nerves with a single injection, SIFIB may be considered a practical alternative for postoperative analgesia in TKA. These findings may assist clinicians in selecting regional anesthesia strategies when procedural limitations exist.

Background and Aims In this study, the effects of ultrasound (US) guided erector spinae plane (ESP) block and pectoralis nerve (PECS) block on acute and chronic pain in patients who underwent breast cancer surgery were studied. Methods Ninety patients were divided into three groups: the ESP, PECS and the control group (ethical approval number-24237859-207). All blocks were applied in the preoperative period using 30 ml of 0.25% bupivacaine (figure 1). The control group received no intervention. The measures recorded were time to onset of block, intraoperative remifentanil consumption, time to first request for analgesia via patient-controlled analgesia (PCA), morphine consumption in the first postoperative 24 hours, the number of patients who requested rescue analgesia, and the visual analogue scale (VAS) pain scores of the arm at rest and in abduction at hours 1, 3, 6, 9, 12, and 24. In addition, the VAS pain scores in the third month following discharge were asked to evaluate the development of chronic pain. Results Both VAS scores, intraoperative remifentanil consumption, and postoperative 24-hour morphine consumption were lower in the ESP and PECS groups compared with the control group. The time to first request for analgesia via PCA was longer in the groups performed block compared with the control group. While the time to onset of block was found to be shorter in the PECS group, none of the patients needed rescue analgesia. Time to onset of block, intraoperative remifentanil and postoperative morphine consumption, the time to first request for analgesia via PCA, and use of rescue analgesia by groups VAS pain scores of the arm at rest and in abduction Conclusions The study demonstrated that the US-guided ESP and PECS block performed in patients who underwent breast cancer surgery provided effective analgesia for acute and chronic pain.