Indian Journal of Anaesthesia最新文献

Background and aims: Paravertebral block (PVB) and erector spinae plane block (ESPB) are commonly used truncal blocks for thoracic and upper abdominal surgeries in adults and children. ESPB is a superficial block, easy to perform, and relatively safe with fewer complications compared to PVB, which is a deeper block, requiring more technical expertise. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) to generate evidence on the analgesic efficacy of ESPB compared with PVB.

Methods: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). We systematically searched PubMed, Scopus, and Google Scholar for RCTs comparing ESPB with PVB in children from inception to date. Time to first rescue analgesic dose was taken as the primary outcome. Analgesic consumption in the first 24 h in the postoperative period, pain scores at different time intervals, and postoperative complications were recorded as secondary outcomes. Random-effects meta-analyses were performed in R (REML estimator), reporting pooled effect, 95% confidence interval (CI), τ², I², and the Q test for heterogeneity.

Results: Four trials (n = 252) were pooled for the time to first rescue analgesia. ESP block was associated with a shorter time to rescue versus PVB: mean difference (MD) = -0.50 h (95% CI: -0.84, -0.17) with negligible heterogeneity (τ² = 0; I² =0%; Q (3) = 0.93, P = 0.818). No significant differences were seen in the pain scores at 0 h SMD = -0.10 (95% CI: 0.41, 0.22); I² = 9.9% (Q (2) = 2.07, P = 0.354) and 12 h SMD = 0.20 (95% CI: -0.20, 0.61); I² = 43.2% (Q (2) = 3.47, P = 0.176). One study reported hematoma in 10% cases, and another study reported pneumothorax in 3% cases in the PVB group. No complications were seen in ESPB group.

Conclusion: The evidence suggests PVB prolongs postoperative analgesia compared to ESPB in children, but with an increased rate of complications.

Background and aims: The external oblique intercostal plane (EOIP) block targets the lateral and anterior branches of T6-T10 intercostal nerves, providing upper abdominal wall analgesia. Its superficial location and ease in the supine position make it a promising option for multimodal analgesia. This systematic review and meta-analysis evaluated its efficacy versus other fascial plane blocks, wound infiltration, or no block in adults undergoing abdominal surgery.

Methods: Following PRISMA guidelines (PROSPERO-CRD420251057391), databases were searched for randomised controlled trials (RCTs) comparing the EOIP block with other fascial plane blocks, wound infiltration, or no block. The primary outcome was 24-hour postoperative opioid consumption. The secondary outcomes were pain scores at rest and movement, intraoperative opioid use, time to first analgesic request, rescue analgesia needs, quality of recovery (QoR)-15 scores, and postoperative nausea and vomiting (PONV). Trial sequential analysis (TSA) was performed to assess the robustness of the primary outcome.

Results: Seventeen RCTs (n = 1032) were included. EOIP block significantly reduced 24-hour opioid consumption [standardised mean difference (SMD): -1.32; 95% confidence interval (CI): -1.83, -0.82; P < 0.001); lowered pain scores at 6, 12, and 24 hours; decreased intraoperative fentanyl use; prolonged analgesia duration; reduced rescue analgesia needs; improved QoR-15 scores; and lowered PONV incidence. TSA confirmed conclusive evidence for EOIP versus no block but indicated further trials are needed versus fascial plane blocks.

Conclusion: As compared to other fascial plane blocks, wound infiltration, or no block, the EOIP block provides opioid-sparing analgesia, sustained pain relief, and enhanced recovery in abdominal surgery. However, due to heterogeneity and a low-to-moderate certainty of evidence, further high-quality RCTs are warranted.

Fascia iliaca compartment block (FICB) is a plane block, targeting the three main branches of the lumbar plexus, including the femoral nerve, lateral femoral cutaneous nerve, and obturator nerve. It is a useful regional anaesthesia technique for lower limb procedures, particularly for hip and knee surgeries. While both traditional landmark-based and newer ultrasound-guided approaches exist, the latter offers more reliable coverage of the target nerves. Through this narrative review, we wish to bring forth the anatomical considerations that need to be kept in mind, as well as the indications and contraindications of administering an ultrasound-guided FICB. The review describes in detail the two main approaches of ultrasound-guided FICB, including the infrainguinal and suprainguinal approaches, with emphasis on the fact that the suprainguinal approach provides a more extensive spread of local anaesthetic (LA), a more reliable blockade of the obturator nerve, greater pain relief, and reduced opioid consumption. Further, being a plane block, a large volume of LA needs to be administered for adequate effect. To conclude, ultrasound-guided FICB is a superficial, safe, and easy-to-learn block with a low complication rate.

Background and aims: The external oblique intercostal (EOI) plane block is a new interfascial plane block covering both the lateral and anterior cutaneous branches of the intercostal nerves. The literature on its use is scarce in paediatric abdominal surgeries.

Methods: Forty American Society of Anesthesiologists physical status I/II patients aged between 2 months and 7 years undergoing upper abdominal surgery with unilateral subcostal incision were randomised: Group E received an ultrasound guided unilateral EOI block using 0.5 mL/kg of 0.2% ropivacaine with general anaesthesia, whereas Group C received general anaesthesia (GA) only. All patients received GA in a standardised manner. Any increase in heart rate or mean arterial pressure of more than 20% was treated with intravenous (IV) fentanyl 0.5 µg/kg. Postoperatively, tramadol 1 mg/kg IV was given as rescue analgesia if the pain score was ≥4. The study's primary outcome was to assess the intraoperative fentanyl consumption. Secondary outcomes included postoperative pain score at 1, 4, 8, 16, and 24 h at rest, time to first rescue analgesic administration, 24 h tramadol consumption, and incidence of side effects such as nausea and vomiting. P <0.05 were considered statistically significant.

Results: The mean intraoperative fentanyl consumption was lower in Group E: 12 [standard deviation (SD: 10.1] [95% confidence interval (CI): 7.3, 16.7] µg as compared to Group C: 20.5 (8.35) [95% CI: 16.7, 24.3] µg (P = 0.005). Total mean 24 h tramadol consumption was statistically lower in Group E: 29.3 (SD: 12.5) [95% CI: 23.4, 35.2] mg vs 62.1 (SD: 19.7) [95% CI: 52.9, 71.3] (P < 0.001). Pain scores were lower in Group E at 1, 4, 8, 16, and 24 h.

Conclusion: The single-shot EOI block can decrease perioperative opioid requirement and pain score. It can form an integral part of a multimodal analgesic regime for upper abdominal surgeries in paediatric patients.

Fascial plane blocks (FPBs) have transformed perioperative analgesia by shifting attention from individual nerves to the complex architecture of fascia and its dynamic role in nociceptive modulation. Despite widespread use, their anatomical foundations, mechanisms of action, and factors influencing injectate spread remain incompletely understood, contributing to inconsistent clinical performance. This manuscript of our two-part review provides a comprehensive, anatomy-driven framework that clarifies the structural diversity of fascial planes, their intrinsic neural components, and the evolving consensus on terminology and classification. Drawing on cadaveric, radiological, and clinical evidence, we dissect the mechanisms that allow FPBs to achieve analgesia-ranging from local fascial modulation and paraneural diffusion to systemic effects-and outline the determinants that shape injectate distribution, including fascial barriers, tissue compliance, patient positioning, and hydrostatic forces. A detailed analysis of interregional nomenclature, unified classification schemes, and persistent knowledge gaps highlights the need for standardisation and mechanistic clarity. Together, these foundational concepts establish the anatomical and physiological bases upon which clinical applications are optimised, enabling a more precise, evidence-based selection and execution of FPBs across surgical and emergency settings.

Background and aims: Chronic knee pain due to osteoarthritis is a prevalent cause of disability. Radiofrequency ablation (RFA) of genicular nerves is a promising approach for alleviating pain and improving function in knee osteoarthritis. This study compares the long term efficacy of cooled and conventional RFA in managing chronic knee pain and disability by observing and comparing pain relief and improvement in functional disability up to 24 months postprocedure.

Methods: Forty patients aged >50 years with Kellgren-Lawrence grade 3 and 4 were enroled. Fluoroscopic-guided genicular nerve ablation was performed on 30 patients: 15 with cooled RFA and 15 with conventional RFA, following positive diagnostic blocks. Pain (Numeric Rating Scale (NRS) and functionality (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score) were assessed at 3, 6, 12, 18, and 24 months. Chi-square test, independent t-test, and paired t-test were used for the statistical analysis. The P ≤0.05 was considered statistically significant.

Results: At 3 months, the Group cooled RFA demonstrated significantly greater reductions in NRS (73.33% vs 53.33%) compared to the Group conventional RFA. Improvement in the WOMAC functional score was found to be better at 3 months in the Group conventional RFA (73.33% vs 66.66%), but at 6-month and subsequent follow-up, the Group cooled RFA had better improvement in functional score. These differences persisted till 24 months, with NRS P < 0.001 and WOMAC P < 0.001 from 6 months onwards. Inter-group comparisons showed significant advantages for cooled RFA in both pain reduction and functional outcomes.

Conclusions: Cooled radiofrequency ablation offers superior long-term benefits in pain relief and functional improvement compared to conventional.