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Future Trends in Regional Anesthesia Techniques

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Essentials of Regional Anesthesia

  • 2016 Accesses

Abstract

Regional anesthesia is a rapidly expanding field within the practice of anesthesiology. The use of peripheral nerve blocks in routine anesthesia care has increased as evidence for better analgesia, and decreased opioid consumption has supported this practice. This chapter highlights several cutting-edge trends within the arena of regional anesthesia. Fascial plane blocks involve the deposition of local anesthetic between fascial planes without targeting a specific nerve; this chapter discusses several new plane blocks, including quadratus lumborum, pectoral, serratus, and erector spinae plane blocks. Furthermore, the advent of ultrasound has allowed visualization of nearby structures and performance of blocks that otherwise may have too low of a safety margin without visualization. This chapter will discuss some of these blocks, such as parasternal and IPACK (interspace between the popliteal artery and capsule of the posterior knee) blocks. Finally, the chapter will summarize evidence behind the use of long-acting local anesthetic drugs as well as innovative ergonomics as a means to improve our work processes.

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Abbreviations

Cm:

Centimeters

IPACK:

Interspace between the popliteal artery and the capsule of the knee

PACU:

Postanesthesia care unit

PECS:

Pectoral nerve block

QL:

Quadratus lumborum

TAP:

Transversus abdominis plane

TKA:

Total knee arthroplasty

TTP:

Transversus thoracic muscle plane

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA

    Amanda Kumar M.D. & Jeff Gadsden M.D., F.R.C.P.C., F.A.N.Z.C.A.

Authors
  1. Amanda Kumar M.D.
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  2. Jeff Gadsden M.D., F.R.C.P.C., F.A.N.Z.C.A.
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Corresponding author

Correspondence to Jeff Gadsden M.D., F.R.C.P.C., F.A.N.Z.C.A. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Electronic Supplementary Material

Single-operator ultrasound-guided perineural catheter insertion. With this grip, the operator can control both the needle and catheter positions, and advance or retract the catheter, while maintaining an appropriate sonographic image using the other hand (MOV 34408 kb)

Review Questions

Review Questions

  1. 1.

    The goal of the transmuscular quadratus lumborum block (also known as QL3) is to deposit local anesthetic between:

    1. (a)

      Latissimus dorsi and erector spinae

    2. (b)

      Quadratus lumborum and erector spinae

    3. (c)

      Quadratus lumborum and psoas major

    4. (d)

      Quadratus lumborum and latissimus dorsi

  2. 2.

    The serratus plane block is intended to provide truncal coverage of which set of dermatomes:

    1. (a)

      T2–T4

    2. (b)

      T2–T6

    3. (c)

      T4–T10

    4. (d)

      T2–T9

  3. 3.

    Complications related to the PECS II block may include:

    1. (a)

      Intravascular injection

    2. (b)

      Bilateral spread

    3. (c)

      High spinal anesthesia

    4. (d)

      All of the above

Answers

  1. 1.

    c

  2. 2.

    c

  3. 3.

    a

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Kumar, A., Gadsden, J. (2018). Future Trends in Regional Anesthesia Techniques. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_39

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_39

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

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