The key to success in blocking lateral cutaneous branches with re-modified thoracoabdominal nerves block through perichondrial approach: a newly discovered space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess.

IF 2.8 3区 医学 Q2 ANESTHESIOLOGY Journal of Anesthesia Pub Date : 2024-10-01 Epub Date: 2024-06-28 DOI:10.1007/s00540-024-03366-w
Yuichi Ohgoshi, Hidaka Anetai, Sayako Hanai, Koichiro Ichimura, Izumi Kawagoe
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Abstract

Purpose: This study aimed to determine whether the administration of a modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) could result in the blockade of the lateral cutaneous branches. This study focused on a newly discovered anatomical space/plane adjacent to the M-TAPA plane, which we termed "space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess: SEDIC."

Methods: Thirteen sides of nine formalin-embalmed cadavers were macroscopically dissected to investigate the anatomical spaces related to the effects of M-TAPA. Furthermore, ten adult volunteers were administered 20 mL of 0.2% ropivacaine into the abdominal plane (corresponding to the M-TAPA plane) and the SEDIC, and a pinprick test was performed 1 h after the injection.

Results: Cadaver macrodissection revealed the presence of the SEDIC adjacent to the M-TAPA plane. The SEDIC was completely spatially isolated from the M-TAPA plane by the presence of costal cartilage and/or tendinous structures. In the volunteer study, the administration of local anesthetics into the SEDIC effectively blocked the lateral cutaneous branches of T8-T12, in addition to the anterior branches.

Conclusion: Our study revealed the presence of the SEDIC adjacent to the M-TAPA plane. Administration of local anesthetics into the SEDIC, named re-modified TAPA, may have the potential to enhance the analgesic effect in the abdominal region.

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通过软骨周围入路,用重新改良的胸腹神经阻断术成功阻断侧皮分支的关键:胸廓内筋膜、膈肌和肋膈凹之间新发现的空间。
目的:本研究旨在确定通过软骨周围入路(M-TAPA)实施改良胸腹神经阻滞术是否会导致外侧皮支阻滞。本研究的重点是新发现的毗邻 M-TAPA 平面的解剖空间/平面,我们称之为 "胸内筋膜、膈肌和肋膈凹之间的空间":方法:对九具福尔马林防腐尸体的 13 个侧面进行宏观解剖,以研究与 M-TAPA 影响相关的解剖空间。此外,向 10 名成年志愿者的腹部平面(与 M-TAPA 平面相对应)和 SEDIC 注射 20 mL 0.2% 罗哌卡因,并在注射 1 h 后进行针刺试验:结果:尸体大体解剖显示,M-TAPA平面附近存在SEDIC。由于肋软骨和/或肌腱结构的存在,SEDIC与M-TAPA平面在空间上完全隔离。在志愿者的研究中,向 SEDIC 施用局部麻醉剂可有效阻断 T8-T12 的外侧皮支和前方皮支:我们的研究揭示了在 M-TAPA 平面附近存在 SEDIC。结论:我们的研究揭示了在 M-TAPA 平面附近存在 SEDIC,在 SEDIC(被命名为重新改良的 TAPA)内施用局麻药可能会增强腹部区域的镇痛效果。
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来源期刊
Journal of Anesthesia
Journal of Anesthesia 医学-麻醉学
CiteScore
5.30
自引率
7.10%
发文量
112
审稿时长
3-8 weeks
期刊介绍: The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
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