Background and objective We report a novel block technique aimed to provide thoracic analgesia: the serratus posterior superior intercostal plane (SPSIP) block. Design A cadaveric evaluation along with a retrospective case series evaluating the potential analgesic effect of the SPSIP block. This study included one unembalmed cadaver and five patients. Interventions Bilateral ultrasound-guided SPSIP block was used on cadavers with 30 mL of methylene blue 0.5% on each side; single-injection SPSIP blocks were used in patients. To measure results, dye spread was used in the cadaver, and dermatomal/pain score evaluation was used in patients. Main results Anatomical investigation in one unembalmed cadaver shows that its mechanism of action covers the rhomboid major muscle, erector spinae muscle, the deep fascia of the subscapularis/serratus anterior muscles, and intercostal nerves. In our patients, SPSIP resulted in an almost complete sensory block in the back of the neck, shoulder, and hemithorax. Conclusion Our cadaveric study shows extensive dye spread from C7 to T7. Patients who were administrated SPSIP block reported consistent dermatomal blockade from C3 to T10 levels of the hemitorax. The SPSIP block seems to be a safe, simple, and effective technique for thoracic analgesia.

Moderate to severe pain may occur following arthroscopic shoulder surgery. An erector spinae plane block (ESPB) may be used for painful conditions of the shoulder. The primary hypothesis of this trial is that ultrasound-guided ESPB would provide effective analgesia by reducing opioid consumption. The secondary hypothesis is that ESPB would result in low pain scores and reduce the use of rescue analgesia. Randomized prospective double-blind study. Academic university hospital. Sixty patients aged between 18 and 65 years designated as American Society of Anesthesiologists (ASA) class I or II who underwent unilateral arthroscopic shoulder surgery under general anesthesia were included in the study. Patients were equally divided into two groups—either the ESPB group (n=30) or the sham block group (n=30). ESPB was performed with 30 mL 0.25% bupivacaine at the T2 level in the ESPB group and sham block with 30 mL saline at the T2 level in the sham block group. Twenty minutes before the end of the operation, 100 mg tramadol was administered intravenously to the patients. Intravenous ibuprofen 400 mg 3 × 1 was ordered for the patients during the postoperative period. A patient control analgesia device including a dose of 10 µg/mL fentanyl was connected to the patients. There were no statistical differences between groups in terms of demographical data. Postoperative fentanyl consumption was significantly lower in the ESPB group than in the sham block group (96.66 µg ±105.57 µg and 230 µg ±247.17 µg, respectively) (P=0.009). The need for rescue analgesia was significantly lower in the ESPB group than in the sham block group (26.66 mg ±35.43 mg and 48.5 mg ±35.45 mg, respectively) (P=0.020). Overall, the visual analog scale scores were significantly lower in the ESPB group than in the sham block group. ESPB may provide effective analgesia treatment following arthroscopic shoulder surgery.

Background: This study aimed to compare the effect of the ultrasound-guided bilateral and bilevel erector spinae plane block (ESPB) on pain scores, opioid requirement, intraoperative motor-evoked potentials (MEPs), and stress response to surgery expressed by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) versus standard analgesia methods following idiopathic scoliosis surgery. Methods: This was a prospective, double-blinded, randomized controlled trial. Sixty patients aged 10 to 18 years and physical status ASA 1 or 2 were randomized into 2 equal groups, each receiving an ESPB or sham block. The primary outcome was the pain scores (Numerical Rating Scale, NRS) within 48 hours after spinal correction and fusion surgery for idiopathic thoracic scoliosis. The secondary outcomes were total opioid consumption, NLR, and PLR levels at 12 and 24 hours postoperatively and intraoperative MEPs. Results: ESPB patients presented lower NRS scores, signifying less pain, at all time points (30, 60, 90, 120 min; and 6, 12, 24, and 48 h after surgery), all P<0.0001. The total opioid consumption, the incidence of nausea or vomiting, and the need for remifentanil and propofol during surgery were significantly lower in the ESPB group. The surgery-induced stress response expressed by NLR and PLR was considerably lower in the ESPB group. ESPB did not affect the intraoperative MEP’s amplitude. Conclusions: ESPB is effective for postoperative analgesia, can reduce opioid consumption in patients undergoing scoliosis surgery, and reduces the stress response to surgery. ESPB does not interfere with neuromonitoring. Level of Evidence: Level I.

Study objective: We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. Design: A cadaveric examination that evaluates the spread of QIP block. Setting: Cadaver laboratory. Patients: One unembalmed cadaver. Interventions: Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. Measurements: Dye spread in cadaver. Main results: There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. Conclusion: The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread. Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions.