Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes

Christopher Wahal, Amanda Kumar, Srinivas Pyati, Christopher Wahal, Amanda Kumar, Srinivas Pyati

Abstract

Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance.

Keywords: Adjuvants; erector spinae block; pectoral nerves block; quadratus lumborum block; regional anaesthesia; transversus abdominis block; ultrasound-guided.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Anatomic view of quadratus lumborum. The lateral (quadratus lumborum 1), posterior (quadratus lumborum 2) and anterior (quadratus lumborum 3) approaches. PM: Psoas major muscle and grey line is transversalis fascia. Adapted with permission from Ueshima et al. -BioMed Research International (open access) Vol 2017, doi 10.1155
Figure 2
Figure 2
Anatomic view of thoracolumbar fascia. The thoracolumbar fascia is divided into three layers, anterior (1), middle (2) and posterior (3). QL: Quadratus lumborum, ES: Erector spinae, LD: Latissimus dorsi. Adapted with permission from Ueshima et al. - BioMed Research International (open access) Vol 2017, doi 10.1155

References

    1. Neal JM, Brull R, Chan VW, Grant SA, Horn JL, Liu SS, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary. Reg Anesth Pain Med. 2010;35:S1–9.
    1. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4.
    1. Sun Y, Li T, Gan TJ. The effects of perioperative regional anesthesia and analgesia on cancer recurrence and survival after oncology surgery: A Systematic review and meta-analysis. Reg Anesth Pain Med. 2015;40:589–98.
    1. Fallatah S, Mousa WF. Multiple levels paravertebral block versus morphine patient-controlled analgesia for postoperative analgesia following breast cancer surgery with unilateral lumpectomy, and axillary lymph nodes dissection. Saudi J Anaesth. 2016;10:13–7.
    1. Gacio MF, Lousame AM, Pereira S, Castro C, Santos J. Paravertebral block for management of acute postoperative pain and intercostobrachial neuralgia in major breast surgery. Rev Bras Anestesiol. 2016;66:475–84.
    1. Blanco R. The 'pecs block': A novel technique for providing analgesia after breast surgery. Anaesthesia. 2011;66:847–8.
    1. Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of pecs II (modified pecs I): A novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.
    1. Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: A randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.
    1. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: A randomized controlled trial. Br J Anaesth. 2016;117:382–6.
    1. Syal K, Chandel A. Comparison of the post-operative analgesic effect of paravertebral block, pectoral nerve block and local infiltration in patients undergoing modified radical mastectomy: A randomised double-blind trial. Indian J Anaesth. 2017;61:643–8.
    1. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: A novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107–13.
    1. Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth. 2017;61:381–6.
    1. Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88–98.
    1. Tran DQ, Elgueta MF, Aliste J, Finlayson RJ. Diaphragm-sparing nerve blocks for shoulder surgery. Reg Anesth Pain Med. 2017;42:32–8.
    1. Bansal V, Shastri U, Canlas C, Gadsden JC. Diaphragm-sparing nerve blocks for shoulder surgery: An alternative approach. Reg Anesth Pain Med. 2017;42:544–5.
    1. Young MJ, Gorlin AW, Modest VE, Quraishi SA. Clinical implications of the transversus abdominis plane block in adults. Anesthesiol Res Pract. 2012;2012:731645.
    1. Bhaskar SB, Balasubramanya H. The transversus abdominis plane block: Case for optimal tap. Indian J Anaesth. 2016;60:231–3.
    1. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35:616–7.
    1. Støving K, Rothe C, Rosenstock CV, Aasvang EK, Lundstrøm LH, Lange KH, et al. Cutaneous sensory block area, muscle-relaxing effect, and block duration of the transversus abdominis plane block: A Randomized, blinded, and placebo-controlled study in healthy volunteers. Reg Anesth Pain Med. 2015;40:355–62.
    1. Gadsden J, Ayad S, Gonzales JJ, Mehta J, Boublik J, Hutchins J, et al. Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries. Local Reg Anesth. 2015;8:113–7.
    1. Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: What is new? Indian J Anaesth. 2017;61:200–14.
    1. Niraj G, Kelkar A, Jeyapalan I, Graff-Baker P, Williams O, Darbar A, et al. Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery. Anaesthesia. 2011;66:465–71.
    1. Basaran B, Basaran A, Kozanhan B, Kasdogan E, Eryilmaz MA, Ozmen S, et al. Analgesia and respiratory function after laparoscopic cholecystectomy in patients receiving ultrasound-guided bilateral oblique subcostal transversus abdominis plane block: A randomized double-blind study. Med Sci Monit. 2015;21:1304–12.
    1. Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: A Meta-analysis. Anesth Analg. 2015;121:1640–54.
    1. Hariharan U, Baduni N, Singh BP. Bilateral rectus sheath block for single-incision laparoscopic tubal ligation in a cardiac patient. J Anaesthesiol Clin Pharmacol. 2016;32:414–5.
    1. Hamill JK, Rahiri JL, Liley A, Hill AG. Rectus sheath and transversus abdominis plane blocks in children: A systematic review and meta-analysis of randomized trials. Paediatr Anaesth. 2016;26:363–71.
    1. Murouchi T, Iwasaki S, Yamakage M. Quadratus lumborum block: Analgesic effects and chronological ropivacaine concentrations after laparoscopic surgery. Reg Anesth Pain Med. 2016;41:146–50.
    1. El-Boghdadly K, Elsharkawy H, Short A, Chin KJ. Quadratus lumborum block nomenclature and anatomical considerations. Reg Anesth Pain Med. 2016;41:548–9.
    1. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A Novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.
    1. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: A Report of 3 cases. Reg Anesth Pain Med. 2017;42:372–6.
    1. Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: A Case report. A A Case Rep. 2017;9:319–21.
    1. Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, et al. Adductor canal block versus femoral nerve block for total knee arthroplasty: A prospective, randomized, controlled trial. Anesthesiology. 2014;120:540–50.
    1. Jæger P, Koscielniak-Nielsen ZJ, Hilsted KL, Fabritius ML, Dahl JB. Adductor canal block with 10 mL versus 30 mL local anesthetics and quadriceps strength: A Paired, blinded, randomized study in healthy volunteers. Reg Anesth Pain Med. 2015;40:553–8.
    1. Hussain N, Ferreri TG, Prusick PJ, Banfield L, Long B, Prusick VR, et al. Adductor canal block versus femoral canal block for total knee arthroplasty: A Meta-analysis: What does the evidence suggest? Reg Anesth Pain Med. 2016;41:314–20.
    1. Burckett-St Laurant D, Peng P, Girón Arango L, Niazi AU, Chan VW, Agur A, et al. The nerves of the adductor canal and the innervation of the knee: An anatomic study. Reg Anesth Pain Med. 2016;41:321–7.
    1. Bendtsen TF, Moriggl B, Chan V, Børglum J. The optimal analgesic block for total knee arthroplasty. Reg Anesth Pain Med. 2016;41:711–9.
    1. Gi E, Yamauchi M, Yamakage M, Kikuchi C, Shimizu H, Okada Y, et al. Effects of local infiltration analgesia for posterior knee pain after total knee arthroplasty: Comparison with sciatic nerve block. J Anesth. 2014;28:696–701.
    1. Malik O, Kaye AD, Kaye A, Belani K, Urman RD. Emerging roles of liposomal bupivacaine in anesthesia practice. J Anaesthesiol Clin Pharmacol. 2017;33:151–6.
    1. Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–7.
    1. Choi S, Rodseth R, McCartney CJ. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: A systematic review and meta-analysis of randomized trials. Br J Anaesth. 2014;112:427–39.
    1. Pani N, Routray SS, Mishra D, Pradhan BK, Mohapatra BP, Swain D, et al. A clinical comparison between 0.5% levobupivacaine and 0.5% levobupivacaine with dexamethasone 8 mg combination in brachial plexus block by the supraclavicular approach. Indian J Anaesth. 2017;61:302–7.
    1. Rahangdale R, Kendall MC, McCarthy RJ, Tureanu L, Doty R, Jr, Weingart A, et al. The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: A randomized, double-blind, placebo-controlled study. Anesth Analg. 2014;118:1113–9.
    1. Kamibayashi T, Maze M. Clinical uses of alpha2 -adrenergic agonists. Anesthesiology. 2000;93:1345–9.
    1. Rancourt MP, Albert NT, Côté M, Létourneau DR, Bernard PM. Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine. Anesth Analg. 2012;115:958–62.
    1. Bharti N, Sardana DK, Bala I. The analgesic efficacy of dexmedetomidine as an adjunct to local anesthetics in supraclavicular brachial plexus block: A Randomized controlled trial. Anesth Analg. 2015;121:1655–60.
    1. Nallam SR, Chiruvella S, Karanam S. Supraclavicular brachial plexus block: Comparison of varying doses of dexmedetomidine combined with levobupivacaine: A double-blind randomised trial. Indian J Anaesth. 2017;61:256–61.
    1. Sharma B, Rupal S, Swami AC, Lata S. Effect of addition of dexmedetomidine to ropivacaine 0.2% for femoral nerve block in patients undergoing unilateral total knee replacement: A randomised double-blind study. Indian J Anaesth. 2016;60:403–8.
    1. Abdallah FW, Dwyer T, Chan VW, Niazi AU, Ogilvie-Harris DJ, Oldfield S, et al. IV and perineural dexmedetomidine similarly prolong the duration of analgesia after interscalene brachial plexus block: A Randomized, three-arm, triple-masked, placebo-controlled trial. Anesthesiology. 2016;124:683–95.
    1. Andersen JH, Grevstad U, Siegel H, Dahl JB, Mathiesen O, Jæger P, et al. Does dexmedetomidine have a perineural mechanism of action when used as an adjuvant to ropivacaine.: A Paired, blinded, randomized trial in healthy volunteers? Anesthesiology. 2017;126:66–73.
    1. Shakhar G, Ben-Eliyahu S. Potential prophylactic measures against postoperative immunosuppression: Could they reduce recurrence rates in oncological patients? Ann Surg Oncol. 2003;10:972–92.
    1. Tsigonis AM, Al-Hamadani M, Linebarger JH, Vang CA, Krause FJ, Johnson JM, et al. Are cure rates for breast cancer improved by local and regional anesthesia? Reg Anesth Pain Med. 2016;41:339–47.
    1. Cummings KC, 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: A population-based study. Anesthesiology. 2012;116:797–806.
    1. Hara K, Sakura S, Yokokawa N, Tadenuma S. Incidence and effects of unintentional intraneural injection during ultrasound-guided subgluteal sciatic nerve block. Reg Anesth Pain Med. 2012;37:289–93.
    1. Cappelleri G, Cedrati VL, Fedele LL, Gemma M, Camici L, Loiero M, et al. Effects of the intraneural and subparaneural ultrasound-guided popliteal sciatic nerve block: A Prospective, randomized, double-blind clinical and electrophysiological comparison. Reg Anesth Pain Med. 2016;41:430–7.
    1. Lupu CM, Kiehl TR, Chan VW, El-Beheiry H, Madden M, Brull R, et al. Nerve expansion seen on ultrasound predicts histologic but not functional nerve injury after intraneural injection in pigs. Reg Anesth Pain Med. 2010;35:132–9.
    1. Gadsden JC, Choi JJ, Lin E, Robinson A. Opening injection pressure consistently detects needle-nerve contact during ultrasound-guided interscalene brachial plexus block. Anesthesiology. 2014;120:1246–53.
    1. Adams AM. Nerve block injection pressure monitoring. Anaesthesia. 2016;71:113–4.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir