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Anaesthesiology
Trunk Interfascial Plane and Nerve Blocks
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
15 sections · 199 slides
Overview
- Scope of this topic
- Structure of this topic
Why block the trunk instead of the spine
- Limitations of neuraxial anaesthesia for the trunk
- Advantages of peripheral trunk blocks
- Haemodynamic profile of paravertebral block
- Common indications for trunk blocks
- Why the lumbar plexus block misses the groin nerves
- Target nerves of the rectus sheath block
- Principle and evolution of the TAP block
The interfascial plane block concept
- Rise of interfascial trunk blocks
- Shift from precision targeting to plane deposition
- Family of interfascial plane blocks
- Sites of the chest wall blocks on one cross section
- Reading the chest wall block map
- Sites of the abdominal wall blocks on one cross section
- Reading the abdominal wall block map
- Landmarks for common ultrasound-guided plane blocks
- Anatomic landmarks for localizing interfascial planes
- Ultrasound scanning approach for each interfascial plane
- Ultrasound scanning approach for each interfascial plane (continued)
Erector spinae plane block
- Definition and location of the erector spinae plane
- Proposed mechanism of the erector spinae plane block
- Landmark technique for the erector spinae plane block
- Ultrasound scanning for the erector spinae plane block
- Needling and injection for the erector spinae plane block
- Safety features and clinical uses of the erector spinae plane block
- Sequence of the ultrasound-guided erector spinae plane block
Paravertebral block
- Indications for paravertebral block
- Paravertebral block compared with general and epidural anaesthesia
- Where paravertebral block is preferred over intercostal block
- Target space and localisation for paravertebral block
- Value and limits of ultrasound for paravertebral block
- Surface landmarks for thoracic paravertebral block
- Needling technique for paravertebral block
- Nerve localisation and loss of resistance for paravertebral block
- Injection volumes and dose limits for paravertebral block
- Preprocedural versus real-time ultrasound imaging
- Ultrasound scanning sequence for thoracic paravertebral block
- Ultrasound appearance of the paravertebral region
- Depth of the paravertebral space on ultrasound
- Visibility of local anaesthetic spread in the paravertebral space
- Vascular puncture and pneumothorax with paravertebral block
- Subarachnoid injection and systemic toxicity with paravertebral block
- Needle angulation rules for ultrasound-guided paravertebral block
- Choosing between paravertebral and intercostal approaches
Intercostal nerve block
- Indications for intercostal nerve block
- Injection sites for intercostal nerve block
- Clinical uses of multi-level intercostal block
- Patient positioning for intercostal nerve block
- Walking the needle off the rib
- Paediatric insertion points and injection volumes
- Ultrasound appearance of the ribs and pleura
- Combining intercostal blocks with other techniques
- Advantages of intercostal block over intravenous opioids
- Pneumothorax risk with intercostal nerve block
- Sedation and blood level hazards in the prone position
- Neuraxial spread and respiratory risk with intercostal block
Serratus anterior plane block
- Anatomy and targets of the serratus anterior plane block
- Landmark technique for the serratus anterior plane block
- Absence of a nerve stimulation endpoint in plane blocks
- Ultrasound scanning for the serratus anterior plane block
- Needling and volume for the serratus anterior plane block
- Order of injection and efficacy of the serratus anterior plane block
Interpectoral and pectoserratus plane blocks
- Origins and targets of the pectoral plane blocks
- Safety profile of the pectoral plane blocks
- Ultrasound scanning for the pectoral plane blocks
- Needling sequence for the pectoral plane blocks
- Complications of the pectoral plane blocks
- Evidence base for the pectoral plane blocks
- Additional indications for the pectoral plane blocks
Abdominal wall blocks
- Landmark technique for the rectus sheath block
- Ultrasound anatomy of the rectus sheath
- Target site and vessel avoidance for the rectus sheath block
- Needling and injection for the rectus sheath block
- Landmark technique for the transversus abdominis plane block
- Ultrasound scanning for the transversus abdominis plane block
- Why the TAP block is a muscular plane block
- Needling and volume for the transversus abdominis plane block
- Clinical applications of the TAP block
- Transversalis fascial plane block variant
- Common ground among abdominal field blocks
- Definition and variants of the quadratus lumborum block
- Proposed mechanism of the quadratus lumborum block
- Nerve coverage and stimulation limits of the quadratus lumborum block
- Ultrasound scanning for the quadratus lumborum block
- The shamrock sign at the level of the transverse process
- Anatomy of the shamrock sign
- Needling the lateral and posterior quadratus lumborum blocks
- Efficacy and hazards of the quadratus lumborum block
- Blind technique for the ilioinguinal and iliohypogastric block
- Ultrasound appearance of the ilioinguinal and iliohypogastric nerves
- Needling and dosing for the ilioinguinal and iliohypogastric block
- Anatomic variability of the groin nerves
- Complications and accuracy of the groin blocks
- Anatomy and indications for penile block
- Technique and dosing for penile block
- Adrenaline contraindication and ultrasound in penile block
Lower extremity blocks
- Combined plexus blockade of the lower extremity
- Indications for peripheral nerve block of the leg
- Coverage of the lower limb nerve blocks
- Rationale for the lumbar plexus (psoas compartment) block
- Coverage and limits of the psoas compartment block
- Surface landmarks for the lumbar plexus block
- Depth of the lumbar plexus
- Needling and nerve localisation for the lumbar plexus block
- Injection and onset for the lumbar plexus block
- Ultrasound assistance for the lumbar plexus block
- Ultrasound appearance at the lumbar plexus
- Continuous catheter placement in the psoas compartment
- Contraindications and complications of the lumbar plexus block
- Terminal nerves of the lumbar plexus
- Indications for obturator nerve block
- Choosing nerve blocks for knee surgery
- Landmarks for femoral nerve block
- Needling and nerve localisation for femoral nerve block
- Fascia iliaca block technique and volumes
- Ultrasound anatomy of the femoral nerve
- Needle alignment for the ultrasound-guided femoral block
- Anisotropy and needle direction at the femoral nerve
- Lateral femoral cutaneous nerve block
- Volume and coverage of the lateral femoral cutaneous nerve block
- Blind approach to the obturator nerve
- Nerve stimulation for the obturator nerve block
- Ultrasound anatomy of the obturator nerve branches
- Depth and appearance of the obturator branches
- Needling and spread for the obturator nerve block
- Landmark triangle and single-injection spread for the obturator nerve
- Approaches and nerve stimulation for saphenous nerve block
- Ultrasound anatomy for the transsartorius saphenous block
- Needling and spread for the ultrasound-guided saphenous block
Sciatic nerve block
- Role and challenges of sciatic nerve block
- Choosing the sciatic block approach
- Surface landmarks for the classical gluteal sciatic block
- Needling and injection for the gluteal sciatic block
- Ultrasound anatomy of the sciatic nerve in the gluteal region
- Sonographic appearance of the gluteal sciatic nerve
- Needling approaches for the gluteal sciatic block
- Positioning and landmarks for the subgluteal sciatic block
- Nerve localisation and dose for the subgluteal sciatic block
- Ultrasound anatomy in the subgluteal region
- Needling angle and spread in the subgluteal sciatic block
- Advantages of the posterior popliteal sciatic block
- Landmarks for the posterior popliteal sciatic block
- Needling and nerve stimulation for the popliteal sciatic block
- Ultrasound anatomy of the popliteal sciatic nerve
- Sonographic appearance at the popliteal fossa
- Needling and spread pattern at the popliteal fossa
- Evidence on injection site at the sciatic bifurcation
- Ultrasound versus nerve stimulation at the popliteal fossa
- Indications for the anterior sciatic nerve block
- Landmarks and needling for the anterior sciatic block
- Ultrasound views of the sciatic nerve from the front of the thigh
- Needle alignment for the anterior sciatic block
- Limits and complications of the anterior sciatic block
- Definition and rationale of the IPACK block
- Evidence position of the IPACK block
- Ultrasound scanning for the IPACK block
- Needling and volume for the IPACK block
- Spillage risk and clinical role of the IPACK block
Ankle block
- Overview of the five nerves of the ankle block
- Landmark technique for posterior tibial nerve block
- Ultrasound anatomy of the posterior tibial nerve at the ankle
- Needle placement for the posterior tibial nerve block
- Landmark technique for deep peroneal nerve block
- Ultrasound anatomy of the deep peroneal nerve at the ankle
- Needling and spread for the deep peroneal nerve block
- Sural nerve block at the ankle
- Saphenous and superficial peroneal blocks at the ankle
- Onset and complications of ankle block
Continuous catheters and neuromodulation
- Catheter-over-needle systems
- Catheter-through-needle versus catheter-over-needle
- Peripheral neuromodulation for acute pain
Summary
- Core principles of interfascial plane blocks
- Recurring safety themes across trunk and limb blocks
- Matching the block to the surgical site
- Unresolved questions in trunk and limb regional anaesthesia
References
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- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition