Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following the advent of intraoperative echocardiography, we are witnessing a potential new revolution for the cardiac anaesthesiologist. A new era has indeed started with the implementation of thoracic fascial blocks (TFBs) in the field of cardiac surgery. TFBs provide several advantages in the context of multimodal analgesia, with improved pain control and reduction of the side effects related to large doses of opioids. We envisage that implementation of TFBs is likely to become a pivotal concept in the field of enhanced recovery after cardiac surgery. We describe the main TFBs for the anterior and/or antero-lateral chest wall, and their peculiar use in cardiac surgery. In particular, we discuss indications and tips and tricks to enhance clinical results for the following blocks: (1) Pecto-Intercostal Plane (superficial and deep); (2) Rectus Sheath; (3) Interpectoral Plane and Pectoserratus Plane; (4) Serratus Anterior Plane; (5) Erector Spinae Plane. Nonetheless, the scientific evidence for the use of TFBs in the field of cardiac anaesthesia is not robust yet, mostly based on small-sized single-centre studies, making it difficult to achieve a high quality of evidence. Further, it remains unclear which cardiac surgery patients may benefit the most from these techniques.

Article: Single shot serratus anterior plane block for post-thoracotomy pain management in cardiac surgery: could it be enough? - Minerva Anestesiologica 2022 May 25 - Minerva Medica - Journals

The anatomy of the sciatic nerve allows it to be blocked at different levels using various anesthetic approaches. However, for several reasons, performing these approaches may be challenging or disadvantageous in specific categories of patients, particularly in obese patients. The objective of this brief technical report is to describe a new technical approach to sciatic nerve block, designed to simplify the procedure for certain categories of patients and less experienced practitioners. Since 2010, more than 5000 procedures have been performed by both experienced anesthesiologists and novice trainees in several hospitals. The ultrasound lateral mid-shaft technique appears to be a safe and effective method for performing a sciatic nerve block, even in obese patients with significant subcutaneous fat and unclear ultrasound images. This approach is particularly beneficial given the various anatomical variations that can occur. By targeting the mid-thigh area, the ultrasound beam accesses anatomical structures that are more superficial, improving the technique’s efficacy. Various hospital groups have been performing this technique as a routine procedure, achieving a success rate of nearly 100%. This impressive success rate exceeds that of other conventional techniques documented in the literature. Additionally, there have been significant improvements in comfort and ease for anesthetists. This method allows the anesthetic to spread around the paraneural sheath, covering the posterior femoral cutaneous nerve. Finally, it is performed in the supine position without the need to mobilize the lower limbs, ensuring patient comfort, especially in cases of fractures or lower limb injuries. Further studies are needed to confirm these results.

Background: Regional anesthesia is a fundamental aspect of contemporary perioperative care. However, variability in practice, incomplete documentation, and inconsistent safety protocols continue to pose preventable risks. Although there are international checklist models for regional anesthesia and perioperative safety such as those developed by ASRA, ESAIC, and the WHO, Italy does not have a nationally endorsed checklist that is consensus-based and specifically tailored to local terminology, workflows, and legal requirements. Methods: To address this gap, we developed an evidence-based Locoregional Anesthesia Checklist (LRA Checklist) using established frameworks for healthcare checklist design. The development process included a needs assessment through a national survey of ESRA Italy members, a review of existing models, item drafting, expert consensus, and endorsement by the Board. We assessed content validity through a modified Delphi process involving 15 experts from the ESRA Italian Chapter Board. Additionally, we created a theoretical impact model to estimate the potential organizational and economic effects of implementing the checklist, using baseline institutional parameters. Results: Consensus was achieved for all checklist domains after two Delphi rounds, with minor edits to improve clarity, usability, and clinical relevance. The theoretical model indicates that adopting checklists may help reduce preventable complications, improve workflow, enhance documentation and traceability, and provide overall benefits to institutions in various scenarios. Conclusions: In conclusion, the LRA Checklist is a structured, consensus-based tool tailored for the Italian context, aimed at promoting safer and more standardized practices in regional anesthesia. To our knowledge, no prior Italian national consensus or checklist specifically dedicated to regional anesthesia has been formally published. Prospective multicenter studies are necessary to confirm its effectiveness in real-world settings and to quantify both clinical and economic outcomes.