Ultrasound-guided truncal blocks: A new frontier in regional anaesthesia

Arunangshu Chakraborty, Rakhi Khemka, Taniya Datta, Arunangshu Chakraborty, Rakhi Khemka, Taniya Datta

Abstract

The practice of regional anaesthesia is rapidly changing with the introduction of ultrasound into the working domain of the anaesthesiologist. New techniques are being pioneered. Among the recent techniques, notable are the truncal blocks, for example, the transversus abdominis plane block, rectus sheath block, hernia block and quadratus lumborum block in the abdomen and the pectoral nerves (Pecs) block 1 and 2, serratus anterior plane block and intercostal nerve block. This narrative review covers the brief anatomical discourse along with technical description of the ultrasound-guided truncal blocks.

Keywords: Pecs block; transversus abdominis plane block; truncal blocks; ultrasound-guided regional anaesthesia.

Figures

Figure 1
Figure 1
Left: Diagram showing the anatomical basis of transversus abdominis plane block and rectus sheath block. Right: ultrasound image of transversus abdominis plane (arrow)
Figure 2
Figure 2
Left: Comparison of sensory block achieved by bilateral rectus sheath block (grey area over midline), bilateral transversus abdominis plane block (green semi-circle over lower abdomen) and unilateral oblique subcostal transversus abdominis plane block (which can vary but approximately covers the area shaded in orange); Right: Above: Ultrasound image of oblique subcostal transversus abdominis plane block: the needle is seen depositing the drug (black area) between the posterior rectus sheath and the transversus abdominis muscle. Below: Rectus sheath block: the needle is seen depositing the drug between the rectus abdominis muscle and the posterior rectus sheath
Figure 3
Figure 3
Quadratus lumborum block: Left: Anatomical basis of anterior and transmuscular approaches. Right above: The transmuscular approach. Right below: The anterior approach
Figure 4
Figure 4
Left above: Anatomical basis of pectoral nerves block. Left below: Initial ultrasound scan showing chest wall muscles, ribs and pleura. Right: Ultrasound images of performing combined Pecs-1 and Pecs-2 blocks in single injection technique

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Source: PubMed

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