Fascia Research Articles

Laparoscopic right hemicolectomy with complete mesocolon excision and cranial approach.

Complete mesocolon excision (CME) and D3-lymphadenectomy concepts have gained popularity for the surgical treatment of right colon cancer in comparison to the conventional laparoscopic right hemicolectomy (CLRH). The rationale of CME is to dissect the embryological planes between the mesenteric plane and the parietal fascia to remove the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains lymph nodes, the central vascular ligation, and adequate bowel length to remove involved pericolic lymph nodes in the longitudinal direction, having as the main goal to improve the oncological results. CME with D3-lymphadenectomy is challenge since involves the excision of the lymph adipose tissue covering the medial edge of the superior mesenteric vein (SMV) (trunk of Gillot, TG), and the gastrocolic trunk of Henle (GTH). We describe a LRH with CME using a cranial approach allowing an easier central vessels origin identification. Through the supramesocolic approach, gastrocolic ligament is opened and the GTH and the middle colic artery (MCA) and vein (MCV) origins are identified. Hepatic flexure is mobilized, and a gauze is placed above the mesenteric vessels. Then, the SMV is identified, dividing the ileocolic vessels origin. The plane between the Gerota and Toldt fascias is opened, identifying duodenum, pancreas, and the gauze previously placed. Following this plane and the SMV along the TG, the GTH and its branches are identified. The superior right colic vein, and the MCA and MCV right branches are divided. After that, colon is fully mobilized laterally opening the parietocolic gutter and an intracorporeal anastomosis is performed. CME could lead to an improvement of oncological results due to a wider mesocolic excision in comparison to conventional D2-lymphadenectomy. Cranial approach facilitates the vessels origin identification to perform a true central ligation.

Multi-objective Optimization of Pelletized Coffee Silver Skin in Flue Gas Torrefaction for Producing Premium Solid Fuel

Multi-objective Optimization of Pelletized Coffee Silver Skin in Flue Gas Torrefaction for Producing Premium Solid Fuel

Clavipectoral fascial plane block for clavicle fracture surgery: A case report.

Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis. A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period. Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.

Comparison of Intrathecal Morphine versus Ultrasound-Guided Regional Analgaesia Techniques for Post-Caesarean Recovery Quality.

To investigate the impact of ultrasound-guided regional analgaesia techniques on postoperative recovery and compare them with those of intratecal morphine (ITM) in obstetric patients undergoing elective caesarean delivery (CD). Observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, Konya City Hospital, Konya, Turkiye, from January to December 2022. The study involved six groups of 30 patients each, categorised by postoperative analgaesia: ITM, posterior transversus abdominis plane block (TAPB), lateral TAPB, transversalis fascia plane block, posterior quadratus lumborum block, and erector spinae plane block. Recovery was assessed using the Obstetric Quality of Recovery Score-10 (ObsQoR-10) at 24 hours, whereas satisfaction was measured with a Likert scale. Time to the first analgaesia, total opioid consumption, nausea, and the need for antiemetics were compared. ObsQoR-10, satisfaction, and numerical rating scale scores were consistent across groups (p >0.05). The lateral TAPB group required more opioids and had earlier analgaesic requests (p = 0.009 and p = 0.05, respectively). ITM was more likely to cause nausea and pruritus compared to regional analgaesia techniques (p = 0.062 and p <0.001). Ultrasound-guided regional analgaesia techniques provided similar postoperative recovery and patient satisfaction levels as ITM. Moreover, regional analgaesia techniques, except lateral TAPB, may offer similar alternatives to ITM within multimodal analgaesia strategies for CD. Caesarean delivery, Multimodal analgaesia, Patient-reported outcome, Regional analgaesia techniques, Quality of recovery.

Optimizing surgical outcomes in recurrent plunging ranula: a case report

A plunging ranula is the extravasation of saliva from the sublingual gland due to trauma or ductal obstruction. The saliva tracks through fascial planes into the submandibular space. While typically originating from the sublingual gland, it rarely involves the submandibular gland. Two types are recognized: simple oral ranula and plunging ranula. Various treatment approaches exist, particularly for preventing recurrence in the plunging type. This case report presents the clinical and radiological findings along with our surgical management of a recurrent plunging ranula using a combined intraoral and extraoral approach with dual salivary gland excision utilising intraoperative ultrasonography to ensure complete excision and prevent recurrence. We present the case of a 16-year-old female with recurrent plunging ranula following incomplete excision of a sublingual ranula in the past. Initially asymptomatic after the first surgery, the patient later developed swelling in the mouth floor and neck. The recurrence was managed using a combined intraoral and extraoral approach for complete excision of the sublingual and submandibular glands, along with the cervical extension of the ranula, guided by intraoperative ultrasonography. Postoperatively, the patient showed no signs of recurrence during follow-up, with complete resolution of symptoms. The combined approach ensured thorough removal of mucus-secreting glands and cystic components, preventing recurrence. The optimal treatment for a plunging ranula involves excision of the lesion and the involved gland. Intraoperative ultrasonography aids in ensuring complete excision of all cystic components, reducing recurrence risk.

Applications And Uses of Coffee Silver Skin (CSS): A Systematic Analysis

Objective: Considerando el tema relativamente nuevo con potencial de exploración, el objetivo fue realizar una revisión sistemática de la literatura sobre el café con piel plateada o Coffee Silver Skin (CSS), así como sus principales aplicaciones y usos en (nuevos) productos, por- productos, aditivos tecnológicos e ingredientes funcionales. Theoretical Framework: During various stages of coffee processing, as well as other crops, by-products are produced in large quantities, generating pollution to the environment, due to their disposal without the appropriate added value that can be achieved with them, if they are studied and approved. for consumption. Among other residues, there is the silver coffee film or Coffee Silver Skin (CSS), obtained in the roasting stage of the beans, highly available in Brazil. Method: The bibliographic method of organization and search was used for the proposed study, bringing a collection of publications on the topic “Coffee Silver Skin”, with quotation marks, from the historical series of the CAFe network on the Periódicos CAPES portal from 2016 to 2024 (until 26/ 09/2024). Results and Discussion: In this research, 29 articles on the topic were used. Only from 2016 onwards did articles begin to be published and have a high degree of impact, and in the year 2023 there was the largest number of publications on this subject with greater relevance and greater impact on the scientific production of the database. data. These numbers demonstrate that this scientific field is still in the process of developing research and techniques. Research Implications: According to the data obtained, we can see that several uses have been indicated for coffee silver film (CSS), such as: phenolic compounds, functional biscuits, sound absorption and other applications in this type of industry, dietary products, fertilizers and covering film for agriculture. Originality/Value: Coffee and coffee waste combined with their high concentration of fiber, coloring pigments, antioxidant compounds and proteins have immense potential as new products and need to be better explored.

The efficacy of transversalis fascia plane block in pediatric inguinal herniotomy: a randomized controlled study.

The post-operative analgesic efficacy of transversalis fascia plane (TFP) block is controversial in pediatric patients undergoing herniotomy. This study aims to compare the efficacy of TFP block and standard analgesic methods. Sixty patients aged 1-8 years who underwent the open procedure of herniotomy were randomly divided into two groups TFP block (n = 30) or control group (n = 30). The TFP group received 0.25% bupivacaine at 0.5 mL/kg. Routine analgesia protocol was applied to Group C. Pain scores (FLACC), family satisfaction, block complications, nausea, sedation score, and additional analgesic requirements were recorded. FLACC pain scores at post-anesthesia care unit (PACU), 1st, 2nd, and 4th h were statistically significantly lower in Group TFP compared to group control (p < 0.05). Three patients in Group TFP and 12 in group control required rescue analgesics at PACU (p = 0.015). Ibuprofen was required in two patients in Group TFP and 11 in Group Control (p = 0.010). Parental satisfaction is higher in the TFP group than in Group Control (p < 0.001). There was no statistically significant difference between the groups in terms of post-operative nausea and sedation scores (p > 0.05). We conclude that TFP block in pediatric patients is an appropriate approach as a part of multimodal analgesia. It creates fewer pain scores in the early post-operative period, requires less additional analgesia, and increases family satisfaction.

Analgesic efficacy of parasternal intercostal plane block for midline sternotomy in adult cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

Background: Regional anesthesia is widely supported as a part of multimodal analgesia for post-operative pain management following cardiac surgery. A common technique for managing post-sternotomy pain is the parasternal intercostal plane (PIP) block, which involves injecting anesthetics into the fascial planes near the sternum to block the anterior cutaneous branches of the T2 &amp;ndash; T6 nerves. Objective: This study aimed to assess the effects of PIP blocks on post-sternotomy pain, narcotic usage, intensive care unit (ICU) stay, and extubation time following adult cardiac surgeries. Methodology: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating PIP blocks in adult cardiac surgery with midline sternotomy. Studies were retrieved from PubMed, Cochrane Library, and Embase through February 22, 2023. The risk of bias (ROB) in RCTs was assessed using the Cochrane ROB tool, version 2. Twelve RCTs involving 819 adult patients were included. Primary outcomes were pain scores at 12 and 24 h post-surgery and narcotic usage in morphine milligram equivalents (MME). Secondary outcomes included extubation time and ICU stay. Results: The PIP block group had significantly lower pain scores at 12 (mean difference [MD]: &amp;minus;1.21 points, 95% confidence interval [CI]: &amp;minus;2.17, &amp;minus;0.25, p = 0.013) and 24 hours (MD: &amp;minus;0.69 points, 95% CI: &amp;minus;1.35, &amp;minus;0.02, p = 0.042), and reduced MME use (MD: &amp;minus;30.34 MME, 95% CI: &amp;minus;45.80, &amp;minus;14.89, p &lt; 0.001). PIP blocks did not significantly reduce extubation time (MD: &amp;minus;0.77 h, 95% CI: &amp;minus;1.64, 0.09, p = 0.080) but were associated with shorter ICU stay (MD: &amp;minus;0.54 days, 95% CI: &amp;minus;0.94, &amp;minus;0.13, p = 0.009). Conclusion: PIP blocks provided effective analgesia and reduced ICU stay in cardiac surgery patients requiring sternotomy, but due to study heterogeneity, results should be interpreted with caution. Future research is warranted to explore its short- and long-term outcomes.

Comparing Analgesic Efficacies of Combined Fascial Plane Blocks for Postoperative Pain Following Laparoscopic Cholecystectomy

Comparing Analgesic Efficacies of Combined Fascial Plane Blocks for Postoperative Pain Following Laparoscopic Cholecystectomy

Extent of abscess development in cervical abscesses and pathogenic bacteria related to swallowing function

Background Deep neck infections (DNIs) in the cervical fascial planes can cause severe complications such as airway obstruction, mediastinitis, and sepsis. Aims/objectives This study examines cervical abscess development, its relationship with postoperative swallowing function, and hospital stay duration. Material and methods A retrospective case series of 55 DNI patients was divided by hospital stay (<30 days: Group A, ≥30 days: Group B) and swallowing recovery (<6 days: Group C, ≥6 days: Group D). Swallowing was assessed using FOIS; abscesses were categorized via CT and surgery. Results Longer hospital stays (Group B) were associated with tracheostomy (p = .027) and thoracoscopic mediastinal drainage (p = .038), shorter time between symptom onset and surgery (p = .016), and abscesses in the anterior cervical (p = .007), retropharyngeal space (p = .026), and mediastinal spaces (p = .002). Dysphagia (Group D) was linked to longer hospital stays (p = .006), more abscesses in the anterior cervical (p = .049) and retropharyngeal spaces (p = .009), and higher cases of intubated feeding (p < .001). Streptococcus constellatus was more prevalent in Group D (p = .04), whereas Staphylococcus aureus was less common (p = .043). Conclusions and significance Dysphagia is associated with abscesses in the anterior cervical and retropharyngeal spaces and higher Streptococcus constellatus prevalence, indicating delayed oral intake recovery. Thoracoscopic mediastinal drainage and shorter time to surgery were linked to prolonged hospital stays.

Back to the Future: Historic Insights and Recent Innovations in Pediatric Regional Anesthesia.

Pediatric regional anesthesia is evolving with new peripheral nerve blocks and techniques aimed at improving perioperative pain management. While caudal blocks have long been standard due to their simplicity and low complication rates, newer fascial plane blocks offer comparable efficacy with enhanced nerve coverage tailored to specific surgeries. Moreover, adjuncts like dexmedetomidine and dexamethasone have shown promise in prolonging block duration and enhancing post-operative pain relief and patient satisfaction. The integration of these advancements into clinical practice has yielded significant benefits, including reduced intraoperative fluid requirements, decreased reliance on opioids postoperatively, earlier initiation of enteral nutrition, lower readmission rates, shorter hospital stays, and decreased overall hospital costs. Our review underscores the technical progress and expanding literature supporting the rapid adoption of these impactful regional anesthesia techniques in pediatric care.

Successful use of ultrasound guided pecto-intercostal fascial plane block to provide intraoperative analgesia in four dogs undergoing median sternotomy.

To evaluate the impact of pecto-intercostal fascial plane block on providing intraoperative analgesia in dogs undergoing median sternotomy. 4 dogs. The dogs were presented with a history of inappetence, lethargy and respiratory distress. Thoracic radiographs, point of care ultrasound, thoracocentesis, bronchoscopy and computed tomography was performed to characterize the disease. 4 male castrated, 5.3 ± 3 years old dogs weighing 19.7 ± 13.5 kg and belonging to Dalmatian, Beagle, Siberian Husky and Rottweiler breeds were included. Three dogs were diagnosed with suppurative pleural effusions because of pulmonary abscesses and one dog with spontaneous pneumothorax due to the presence of pulmonary bullae. All dogs underwent median sternotomy under general anesthesia to explore the thorax. A pecto-intercostal fascial plane block was performed by injecting local anesthetic bupivacaine in the parasternal fascial plane between the deep pectoral and external intercostal muscles to provide antinociception by anesthetizing ventral cutaneous branches of intercostal nerves second through sixth. Analgesia from the block resulted in reduced requirement of inhalant anesthesia and minimal requirement for opioid to augment analgesia intraoperatively. Median sternotomy is required to perform thoracic surgery in dogs with various thoracic pathologies. Pecto-intercostal fascial plane block is a locoregional technique that can blunt nociception arising from the ventral thorax and can significantly improve perioperative patient care in dogs undergoing median sternotomy by providing effective intraoperative and potentially postoperative analgesia.

Facing a new reality: significant increase in necrotizing fasciitis in the post-covid era?

Necrotizing fasciitis (NF) is a rare, rapidly progressing soft tissue infection characterized by the widespread necrosis of fascial planes and surrounding tissues. We discuss four consecutive necrotizing fasciitis cases of the head and neck region, that accured in a time window of 6 months. Patient demographics, clinical features, laboratory analyses, imaging findings, surgical interventions, and outcome were collected, assessed and discussed. These findings were checked against recent epidemiological data of invasive Group A Streptococcus (iGAS) in Europe. Four patients (two males and two females) aged between 31 and 65 years were included. The most common presenting symptom was severe pain and facial swelling (100%), followed by fever (50%) and erythema (50%). All patients underwent emergency surgical debridement, and broad-spectrum antimicrobial therapy was initiated promptly. Streptococcus pyogenes was isolated in every patient. Three patients required multiple debridement procedures, and one case necessitated extensive neck resection due to the involvement of deeper structures. Overall, two patients recovered with no to minor residual deficits, one patient experienced persistent trismus and one patient passed away due to septic shock and multiorgan failure. Prevalence of iGAS infections have increased in European countries, therefore increased vigilance is recommended so that a quick diagnosis can be established and appropriate treatment can be administered to avoid serious morbidity and mortality.

Perioperative pain management for cardiac surgery.

Acute postsurgical pain after cardiac surgery is challenging to treat. Adverse effects related to the high dose opioids which have traditionally been used perioperatively in cardiac surgery have led to the adoption of alternative analgesic strategies. This review aims to highlight current evidence-based approaches to managing pain after cardiac surgery. Current evidence and international guidelines support the use of multimodal analgesics for managing perioperative pain after cardiac surgery. Regional anaesthesia in the form of fascial plane blocks, such as the erector spinae plane and parasternal intercostal plane blocks, are effective and safe techniques for anticoagulated cardiac surgery patients. Transitional pain services are multidisciplinary programmes that bridge the gap between inpatient and outpatient care for these patients. This paper reviews advancements in perioperative pain management for cardiac surgery patients, emphasising the shift from high-dose opioids to multimodal analgesia and regional anaesthetic techniques, and highlighting the role of multidisciplinary transitional pain services.

Midclavicle block: An anatomical study.

Recent studies indicate that clavipectoral fascia plane block (CPB) efficacy may stem from injectate distribution to the anterosuperior clavicular periosteum. We conducted an anatomical study combining the CPB with injection within the subclavius muscle. Our hypothesis was that the anaesthetic injectate would fully cover both the anterosuperior and posteroinferior surfaces of the clavicular periosteum in the midclavicular region. Observational human cadaver study. Laboratory of Surgical Neuroanatomy, Unit of Anatomy and Human Embryology of the Faculty of Medicine and Health Sciences, University of Barcelona. Five fresh human cadavers. The cadavers received both a CPB and subclavius muscle injections under ultrasound guidance in 10 clavicular regions. After the procedures on the cadaveric models, an anatomical dissection by planes was performed to evaluate the distribution pattern of methylene blue on the clavicular periosteum. A probabilistic map of the colour spectrum and staining temperature on the clavicular surfaces was generated. Methylene blue stained 37 ± 16% of the anterosuperior surface and 23 ± 13% of the posteroinferior surface of the clavicular periosteum, particularly in the middle third of each surface. Although the staining did not achieve complete circumferential coverage or perfect alignment between the surfaces, the areas exhibited a close relationship, indicating significant distribution and relevant coverage. Our anatomical study demonstrates that the midclavicular block achieves effective distribution around the middle third of the clavicle, although complete circumferential anaesthesia of the clavicular periosteum was not achieved. Although this block may provide periosteal and bone anaesthesia, it does not address other sources of pain, such as muscle spasms and skin components. Additional clinical studies are needed to evaluate the overall efficacy of this dual block technique for clavicle surgery.

Comparison of combined deep and superficial serratus anterior block with thoracic paravertebral block for postoperative pain in patients undergoing video-assisted thoracoscopic surgery.

Thoracic paravertebral block (TPVB) is a well-established procedure for the management of postoperative pain in patients undergoing video-assisted thoracic surgery (VATS). In recent years, there have been studies suggesting that fascial plane blocks may be an alternative to TPVB. The objective of our study was to determine the efficacy of combined deep and superficial serratus anterior block (C-SAPB) as an alternative to TPVB in the management of postoperative analgesia in VATS. The patients were divided into two groups: the TPVB group and the C-SAPB group. Both groups were administered the same dose of local anesthetics. Multimodal analgesia was achieved for the groups. The primary outcome measure was visual analog scale (VAS) pain scores recorded within the first 48 h of the postoperative period in each group. The secondary outcomes were analgesic requirement, rescue analgesics, complications rate, and postoperative patient satisfaction. Thirty patients with C-SAPB and 30 patients with TPVB were analysed. VAS rest and VAS coughing scores were similar between the groups (p > 0.05). Demographic and side effect conditions, total morphine use, additional analgesic needs, vital parameters, block procedure time, and patient satisfaction were also similar between the groups (p > 0.05). Additionally, although block application times were comparable, the time was slightly shorter in C-SAPB. Similar analgesic efficacy was observed between C-SAPB and TPVB. TPVB maintains its place among the first choices in VATS. The efficacy of C-SAPB is comparable to that of TPVB. While the duration of C-SAPB application is not a significant factor, the brief nature of the procedure and its straightforward administration suggest that it may be an effective method.

Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial

Background &amp; objective: Both, the clavipectoral fascial plane block as well as superficial cervical plane block have been utilized as a regional anesthesia technique for clavicular fracture surgery. We compared the efficacy and safety of clavipectoral plane block with superficial cervical plexus block for intraoperative and postoperative pain relief in clavicular fracture surgery under general anesthesia (GA). Methodology: This double-blinded randomized controlled trial included 84 patients, aged between 21 and 60 y, ASA classification I and II, with fracture clavicle, either isolated or part of other trauma, undergoing fracture clavicle fixation. The patients were divided into two groups. The first group received a clavipectoral fascial plane block and the other received a superficial cervical plane block. The visual analogue scale (VAS) scores were recorded as primary outcome, while the patients’ hemodynamics, time to first rescue analgesic, and total morphine consumption were the secondary outcomes at post-anesthesia care unit (PACU) then every 2 h in the ward till 8 h. Results: Compared to the superficial cervical plexus block the clavipectoral plane block was superior in analgesia and more effective during surgical dissection and intraoperative manipulations with a clinically and statistically significant difference all the time from PACU to 8 h postoperatively. The heart rate and arterial blood pressure were much more stable in the clavipectoral group. Also, time to first rescue analgesic was more in the clavipectoral group than in the superficial cervical block. Total morphine consumption was significantly less in the clavipectoral group than in the superficial cervical group. Conclusion: Clavipectoral plane bock is superior to superficial cervical block in fracture clavicle surgeries regarding efficacy and safety. Postoperative pain, measured by VAS, was less with clavipectoral plane block, with more hemodynamic stability and less opioid consumption postoperatively. Abbreviations: PACU - post-anesthesia care unit; CFP - Clavipectoral fascial plane; SCP - Superficial cervical plexus Keywords: Clavipectoral Plane Bock; Fracture Clavicle; Pain, Postoperative; Superficial Cervical Plexus Block Citation: Sayed AG, Abdelmoez WA, Ali OM, Elshafeey AE. Clavipectoral fascial plane block versus superficial cervical plexus block for fracture clavicle surgery: a randomized clinical trial. Anaesth. pain intensive care 2024;28(5):945−950; DOI: 10.35975/apic.v28i5.2573 Received: April 03, 2024; Reviewed: May 13, 2024; Accepted: July 02, 2024

Computed tomographic features of Morel-Lavallée lesions in 3 cats.

To describe the CT features of Morel-Lavallée lesions (MLLs) and their association with trauma in cats. This study aimed to investigate whether MLL fluid in cats accumulates between the dermis and deep fascia near superficial trauma, exhibits a vertical attenuation gradient, and shows no or only mild contrast enhancement on CT images. 3 young cats: a 1-year-old neutered male domestic shorthair cat, a 2-year-old neutered male domestic shorthair cat, and a 3-year-old neutered female British Shorthair cat. The clinical presentation of the 3 cats in the study involved recurrent swelling and fluid accumulation affecting at least 1 pelvic limb following trauma. In all cases, there was a fluid-filled space deep to the skin and superficial subcutaneous layer but superficial to the deep fascial plane overlying the muscular component of the pelvic limbs. The MLL fluid had a vertical attenuation gradient and no or only mild contrast enhancement. Morel-Lavallée lesions are often initially overlooked, likely due to distraction by concomitant significant bone injuries, and can be mistaken for hematomas, seromas, subcutaneous edema, contusions, or cellulitis, leading to less aggressive treatment. If left untreated, MLLs present a significant risk of extensive skin necrosis compared to other types of subcutaneous swelling.

Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research.

Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate the exploration of alternatives. This narrative review highlights the potential of nerve blocks as a safe and effective strategy for post-surgical pain control. This review explores the use of various nerve block techniques tailored to specific surgical procedures. These include nerve blocks for abdominal surgeries; fascial plane blocks for chest surgeries; nerve blocks for arm surgeries; and nerve blocks for lower limb surgery including; femoral, hip, and knee surgeries. By targeting specific nerves, these blocks can provide targeted pain relief without the negative side effects associated with opioids. Emerging evidence suggests that nerve blocks can be as effective as opioids in managing pain, while potentially offering additional benefits such as faster recovery, improved patient satisfaction, and reduced reliance on opioids. However, the effectiveness of nerve blocks varies depending on type of surgery, and in individual patients. Rebound pain, which temporary increase in pain after a block wears off, can occur. In addition, some techniques require specialized guidance for accurate placement. In conclusion, nerve blocks show great promise as effective alternatives for managing post-surgical pain. They can reduce the need for opioids and their side effects, leading to better patient outcomes and satisfaction. Future studies should assess the long-term impacts of specific nerve blocks on mortality rates, cost-effectiveness, and their incorporation into multimodal pain management approaches to further enhance post-surgical care.

To Study the Efficacy of Ultrasound Guided Pecto-Intercostal Fascial Plane Block in Patients Undergoing Midline Sternotomy in Open Cardiac Surgery: A Randomized Prospective Comparative Study.

The incidence of acute poststernotomy pain after cardiac surgery is 80%1. Pecto-intercostal fascial plane block (PIFB) adjacent to the sternum anesthetizes the anterior cutaneous branches of the intercostal nerves and may provide effective analgesia after sternotomy. A randomized controlled, double-blinded, prospective comparative trial was conducted at a tertiary care center on patients of midline sternotomy between 18 and 65 years and NYHA Class 2 and 3 for open cardiac surgery with the primary aim to evaluate analgesia on deep breathing after 3 hours of PIFB block bilaterally. A total of 60 patients were enrolled and randomly divided into three groups. PIFB was administered bilaterally before extubation, with 15 ml 0.125% bupivacaine plain (Group B), and bupivacaine+ clonidine 0.25 mcg/kg (Group B+C). Group C did not receive any intervention. All patients received acetaminophen 1 gram three times a day and injectable tramadol 1 mg/kg as a rescue analgesic. Baseline characteristics were similar among all the groups. The Numeric Rating Scale (NRS) for pain was statistically lower (P < 0.05) in Groups B and B+C compared to Group C at rest, deep breathing, and coughing at 3, 6, and 12 hours after extubation. NRS on deep breathing in Groups B, B+C, and C was {(2.3, 1.5, 4.4) at 3 hours, (2.3, 1.6, 4.3) at 6 hours, (2.8, 2.1, 3.9) at 12 hrs, and {(4.3, 3.5, 3.6)} at 24 hours after extubation. The peak expiratory flow rate was the highest in Group B. Rescue analgesia was not required in Group B. PIFB reduces sternotomy pain compared to the control group on deep breathing at 3 hours after block, with delayed requirement of rescue analgesia and improved respiratory mechanics in terms of peak expiratory flow rate at all time points. There is no benefit from adding clonidine.