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Perez‐Herrero MA, Fajardo M, Galluccio F, Yamak Altinpulluk E, Espinoza K. The spread of injectate after deep serratus anterior plane and superficial parasternal intercostal plane blocks: a cadaveric dye study. Anaesth Rep 2024; 12:e12297. [PMID: 38800554 PMCID: PMC11116942 DOI: 10.1002/anr3.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
We investigated the distribution of injected dye after deep serratus anterior plane and superficial parasternal intercostal plane blocks in 15 Thiel embalmed cadavers. We injected 0.4 ml.kg-1 of 0.25% aqueous methylene blue solution into the deep serratus anterior and superficial parasternal intercostal planes using real-time ultrasound needle visualisation followed by posterior dissection to observe the distribution of the injected dye in the chest wall. The two blocks were performed bilaterally in 15 cadavers at the T5/T6 level, comprising 60 blocks in 30 hemithoraces in total. At dissection, the intercostal nerve territories were observed to be dyed completely from T2 to T6 in 28 of 30 hemithoraces, and extending caudal to T6 in 10 hemithoraces. Following the deep serratus anterior plane blocks in all cadavers, the dye was found to have spread to the axillae. Following the superficial parasternal intercostal plane blocks, the dye reached T7 in four cadaver dissections. We concluded that the territories innervated by the intercostal nerves (T2-T6 dermatomes) are dyed following the combination of the two blocks when performed at the T5-T6 intercostal space level. These techniques might provide an effective option for anaesthesia in breast surgery.
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Affiliation(s)
- M. A. Perez‐Herrero
- Department of AnaesthesiologyClinical University Hospital in ValladolidSpain
| | - M. Fajardo
- Health Sciences DepartmentUniversity of Rey Juan CarlosMadridSpain
| | - F. Galluccio
- Department of Rheumatology and Pain ManagementFisiotech Lab StudioFirenzeItaly
| | - E. Yamak Altinpulluk
- Morphological Madrid Research Center, UltraDissection Spain EchoTraining SchoolMadridSpain
| | - K. Espinoza
- Anesthesiology DepartmentHospital Cais de PuriscalSan JoséCosta Rica
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Abd El-Aziz RAER, Asal MF, Maaly AM. Effectiveness of adding magnesium sulfate to bupivacaine in ultrasound guided serratus anterior plane block in patients undergoing modified radical mastectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2168856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Rehab Abd El-Raof Abd El-Aziz
- Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Frouk Asal
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ayman M. Maaly
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Saravanan R, Venkatraman R, Karthika U. Comparison of Ultrasound-Guided Modified BRILMA Block with Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy - A Randomized Controlled Trial. Local Reg Anesth 2021; 14:109-116. [PMID: 34239324 PMCID: PMC8259940 DOI: 10.2147/lra.s316320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Subcostal Transversus Abdominis Plane (TAP) block is the standard practice for postoperative analgesia following laparoscopic cholecystectomy. This study aimed to compare the efficacy of modified BRILMA Block (blocking the BRanches of Intercostal nerves at the Level of Mid-Axillary line) with Subcostal TAP block for pain relief following laparoscopic cholecystectomy. Methods Sixty cases scheduled for laparoscopic cholecystectomy were randomly divided into two groups: modified BRILMA block (Group B) and Subcostal TAP block (Group T). General anesthesia was standardized for both groups. Blocks were performed with 20 mL of 0.2% Ropivacaine under ultrasound guidance after induction of anesthesia. Patients were administered morphine through patient controlled analgesia (PCA) pump with a bolus dose of 1 mg, 10 min lockout interval, and a basal infusion rate of 0.1 mg/h. The pain was assessed by the Visual Analog Scale (VAS) scores of one to ten. The total morphine consumption, time to first request for rescue analgesia, and VAS scores at rest and with movement, and complications, if any, were recorded. Results The morphine consumption in Group B was 5.67 ± 1.98 mg and in Group T was 5.17 ± 1.85 mg, which was found to be statistically insignificant (p-value = 0.317). The time to first request for rescue analgesia was 759.33 ± 80.29 min in Group B which was comparable to 854 ± 93.01 min in Group T and statistically insignificant (p-value = 0.295). The average VAS scores at rest as well as on movement were comparable in both the groups during the entire 24 h postoperative period. No complications were encountered in our study. Conclusion Ultrasound-guided modified BRILMA block is equally efficacious as subcostal TAP block in providing postoperative analgesia with similar morphine consumption and no significant difference in VAS scores at rest and movement following laparoscopic cholecystectomy. Trial Registration Number CTRI/2020/02/023457.
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Affiliation(s)
- Ravi Saravanan
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Rajagopalan Venkatraman
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
| | - Urkavalan Karthika
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, 603203, India
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Yu LS, Lei YQ, Liu JF, Wang J, Wang ZC, Chen Q. Remifentanil-based fast-track cardiac anesthesia combined with the postoperative serratus anterior plane block for transthoracic device closure of atrial septal defect in pediatric patients. J Card Surg 2021; 36:2263-2268. [PMID: 33811664 DOI: 10.1111/jocs.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/30/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the safety and effectiveness of remifentanil-based fast-track cardiac anesthesia (FTCA) combined with the postoperative serratus anterior plane block (SAPB) for transthoracic device closure of atrial septal defect (ASD) in pediatric patients. METHODS A total of 70 children who underwent transthoracic device closure of ASDs from January 2018 to June 2020 were divided into two groups according to different anesthesia strategies administered, namely group F (fast-track anesthesia, n = 38) and group R (routine anesthesia, n = 32), and relevant clinical data were collected and analyzed. RESULTS There was no statistically significant difference between the two groups in general preoperative data, intraoperative hemodynamics, and FLACC score 1 h after extubation (p > .05). FLACC score of Group F was significantly lower than that of group R at 4, 8, 12, and 24 h after extubation (p < .05). The number of postoperative PCA press and the dose of PCA infusion in group F were lower than those in group R (p < .05). The mechanical ventilation duration, the length of intensive care unit stay in group F were statistically significantly lower than those in group R (p < .05). CONCLUSION Remifentanil-based FTCA combined with the postoperative SAPB for transthoracic device closure of ASD in pediatric patients could effectively reduce postoperative pain of the children.
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Affiliation(s)
- Ling-Shan Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China
| | - Yu-Qing Lei
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China
| | - Jian-Feng Liu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China
| | - Jing Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiac Surgery, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Cardiac Surgery, Fujian Children's Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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El Sherif FA, Abd El-Rahman AM, Othman AH, Shouman SA, Omran MM, Hassan NA, Hassan SB, Aboeleuon E. Analgesic Effect of Morphine Added to Bupivacaine in Serratus Anterior Plane Block Following Modified Radical Mastectomy. Only a Local Effect? Randomized Clinical Trial. J Pain Res 2020; 13:661-668. [PMID: 32280268 PMCID: PMC7127777 DOI: 10.2147/jpr.s236336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Serratus anterior plane (SAP) block, a novel regional anesthetic procedure, involves the anterolateral chest wall. Opioid receptors have been found on peripheral nerve terminals, so morphine may have a local action. Objective This work aimed at exploring the analgesic efficacy of morphine added to bupivacaine in SAPB in patients for whom modified radical mastectomy was conducted and whether it is a mere local effect. Methods Forty female patients were planned to have modified radical mastectomy participated in the study. Patients were randomly divided into two groups; Control group (C): received ultrasound-guided serratus anterior plane block with 20 mL of bupivacaine hydrochloride 0.25%; Morphine group (M): received the same in addition to 10 mg morphine sulfate. Intra- and post-operative blood samples were taken for the assessment of morphine serum levels. All patients were assessed for VAS scores during rest and movement (VAS-R and VAS-M). Time to the first request and the total amount of the rescue analgesia were recorded. Results In group M, Morphine was not detected in the plasma of all patients. Both VAS-R and VAS-M were significantly higher in group C than in group M (P<0.001) and (P≤0.003), respectively. Time to the first request of rescue analgesia was 8.5 h in group C compared to 20 h in group M (P=0.005) with a median dose of acetaminophen consumption of 2 g in group C compared to 1 g in group M (P=0.006). Conclusion Ten mg of morphine, when added to bupivacaine in SAPB, improved postoperative analgesia in patients to whom modified radical mastectomy was conducted. This effect seems to be attributed merely to local mechanisms. Registration The registration number of this study is NCT02962024 at www.clinicaltrial.gov.
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Affiliation(s)
- Fatma A El Sherif
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmad M Abd El-Rahman
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed H Othman
- Anesthesia, ICU, and Pain Relief, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Samia A Shouman
- Cancer Biology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mervat M Omran
- Cancer Biology (Pharmacology and Experimental Oncology), National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nivin A Hassan
- Cancer Biology (Pharmacology and Experimental Oncology), South Egypt Cancer Institute, Assuit University, Assiut, Egypt
| | - Sahar B Hassan
- Clinical Pharmacy, Faculty of Pharmacy, Assuit University, Assiut, Egypt
| | - Ebrahim Aboeleuon
- Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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Silva Pereira T, Rodrigues Silva C, Veiga NF, Alfaro de la Torre P, Kabiri-Sacramento M. BRILMA block for costal cartilage excision: Case report. ACTA ACUST UNITED AC 2020; 67:271-274. [PMID: 32143823 DOI: 10.1016/j.redar.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/10/2020] [Indexed: 10/24/2022]
Abstract
The block of the lateral branches of the intercostal nerves in the middle axillary line (BRILMA) is an interfascial ultrasound-guided block for analgesia in thoracic wall and upper abdominal surgery, presenting as an adequate alternative to neuraxial techniques. We present the case of a 49-year-old female scheduled for idiopathic subglottic stenosis repair with a costal cartilage graft from the 10th rib and tracheotomy. At the end of the surgery, unilateral ultrasound-guided BRILMA block with 20ml of ropivacaine 0.2% was performed at the level of the 6th rib, uneventfully. Postoperatively, the patient referred a maximum level of pain of 3/10. There was no opioid consumption after the 2nd postoperative day, although a subcostal incision may produce considerable pain. BRILMA is a superficial block, easily reproducible in most patients. It diminishes the number of punctures needed in the thoracic wall, as well as the risk for pneumothorax and local anesthetic toxicity.
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Affiliation(s)
- T Silva Pereira
- Departamento de Anestesiología, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | - C Rodrigues Silva
- Departamento de Anestesiología, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - N F Veiga
- Departamento de Anestesiología, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - P Alfaro de la Torre
- Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Joan XXIII, Tarragona, España
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7
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BRILMA and PEC blocks: Simpler and more adequate options in radical breast surgery. ACTA ACUST UNITED AC 2020; 65:478-479. [PMID: 29773303 DOI: 10.1016/j.redar.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/21/2022]
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8
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González-García J, González-Bada A, López-Ramos JM, Echevarria-Correas MA, Muñecas-Herreras MBG, Aguilera-Celorrio L. Prospective, randomized comparative study of ultrasound-guided blocking of the lateral cutaneous branches of the intercostal nerves versus conventional analgesia in non-reconstructive breast surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:137-143. [PMID: 30545702 DOI: 10.1016/j.redar.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this study is to determine whether the accomplishment of an interfascial blockade, the blocking of the cutaneous branches of the intercostal nerves in the axillary line (BRILMA) associated with a multimodal analgesic regimen improves post-operative analgesia and allows saving opioids after non-reconstructive surgery of breast. MATERIAL AND METHODS A prospective, randomised and simple blind study was conducted on patients that underwent non-reconstructive breast surgery. The patients were randomly assigned to the blocking group, or to the standard post-operative analgesia group (paracetamol and dexketoprofen). The main variables analysed were the pain intensity assessed by the verbal numerical scale and the analgesic rescue needs with tramadol. RESULTS Statistically significant differences were observed in the consumption of tramadol during the study period (10.5mg in the BRILMA group, compared to 34.3 in the control group, P=.0001). There were also differences in the pain assessment, with lower values found in the BRILMA group. CONCLUSIONS In non-reconstructive breast surgery, performing a BRILMA block allows obtaining lower pain scores, which implies less need for rescue analgesics and a significant saving of tramadol in the study period.
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Affiliation(s)
- J González-García
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España.
| | - A González-Bada
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - J M López-Ramos
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - M A Echevarria-Correas
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - M B G Muñecas-Herreras
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - L Aguilera-Celorrio
- Servicio de Anestesia y Reanimación, Hospital Universitario Basurto, Bilbao, Vizcaya, España
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Mazzinari G, Rovira L, Casasempere A, Ortega J, Cort L, Esparza-Miñana JM, Belaouchi M. Interfascial block at the serratus muscle plane versus conventional analgesia in breast surgery: a randomized controlled trial. Reg Anesth Pain Med 2019; 44:52-58. [DOI: 10.1136/rapm-2018-000004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
Abstract
Background and objectivesIn the context of opioid-sparing perioperative management, there is still little evidence from randomized controlled trials regarding the effectiveness of interfascial thoracic blocks. This study hypothesizes that receiving a serratus plane block reduces opioid requirements, pain scores, and rescue medication needs.MethodsThis double-blind, randomized controlled study was conducted on 60 adult females undergoing oncologic breast surgery. After general anesthesia, patients were randomly allocated to either conventional analgesia (control group, n=30) or single-injection serratus block with L-bupivacaine 0.25% 30mL (study group, n=30). First 24-hour total morphine consumption (primary outcome), pain scores at 1, 3, 6, 12, and 24 hours, time-to-first opioid rescue analgesia, and adverse effects were recorded.ResultsMedian 24 hours’ opioid dose was greater in the control group (median difference 9 mg (95% CI 4 to 14.5 mg); p<0.001). Proportional odds model showed that the study group has a lower probability of receiving opioid drugs (OR=0.26 (95% CI 0.10 to 0.68); p<0.001), while mastectomies have a higher probability of receiving them (OR=4.11 (95% CI 1.25 to 13.58); p=0.002). Pain scores in the study group were significantly lower throughout the follow-up period (p<0.001). Control group subjects needed earlier morphine rescue and had a higher risk of rescue dose requirement (p=0.002).ConclusionsInterfascial serratus plane block reduces opioid requirements and is associated with better pain scores and lower and later rescue analgesia needs in the first 24 hours, compared with conventional intravenous analgesia, in breast surgery.Trial registration numberNCT02905149.
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Sanllorente-Sebastián R, de Vicente-Lorenzo JM, Mediavilla-Herrera FJ, Gutiérrez-García S, Alario-Poza IS, Bustinza-Beaskoetxea Z. Case report: serratus intercostal plane block/BRILMA and sedation for mastectomy in a high risk patient. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:46-48. [PMID: 30115502 DOI: 10.1016/j.redar.2018.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
Breast cancer surgery can benefit from regional anaesthesia techniques, which can be used as a sole anaesthetic procedure in some cases where risk for general anaesthesia is high. Regional anaesthesia allows early recovery, reduces postoperative opioid and non opioid analgesics consumption and helps early home discharge, reducing thus costs. We present a case of an 87-year-old woman with multiple comorbidities who underwent breast cancer surgery. The patient was successfully surgically treated under serratus intercostal plane block anaesthesia. We discuss the use and benefits of the serratus intercostal plane block in thoracic procedures.
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Affiliation(s)
| | - J M de Vicente-Lorenzo
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - F J Mediavilla-Herrera
- Departamento de Anestesia y Reanimación, Hospital Universitario de Burgos, Burgos, España
| | - S Gutiérrez-García
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - I S Alario-Poza
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
| | - Z Bustinza-Beaskoetxea
- Departamento de Obstetricia y Ginecología, Hospital Universitario de Burgos, Burgos, España
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Varela O, Melone A, López-Menchaca R, Sevilla R, Callejo D, López-Álvarez S, Román Fernández A, García S, Mantilla I, Zaballos M. Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:441-446. [PMID: 29887291 DOI: 10.1016/j.redar.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 05/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. RESULTS Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). CONCLUSION The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered.
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Affiliation(s)
- O Varela
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - A Melone
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R López-Menchaca
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R Sevilla
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - D Callejo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - S López-Álvarez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - A Román Fernández
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complejo Hospitalario Universitario Álvaro Cunqueiro, Vigo, España
| | - S García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - I Mantilla
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Zaballos
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
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Interfascial intercostal nerves block. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Shah S, Hariharan U, Bhargava A. Recent trends in anaesthesia and analgesia for breast cancer surgery. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fernández Martín MT, López Álvarez S, Pérez Herrero MA. Serratus-intercostal interfascial block as an opioid-saving strategy in supra-umbilical open surgery. ACTA ACUST UNITED AC 2018; 65:456-460. [PMID: 29789137 DOI: 10.1016/j.redar.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The administration of local anaesthetic in the serratus-intercostal space provides adequate analgesia in non-reconstructive breast surgery. The aim of this study was to evaluate whether the blockage of the last intercostal nerves (T7-T11) can lead to opioid savings in supra-umbilical open surgery procedures. MATERIAL AND METHODS A prospective observational study was conducted on patients undergoing open supra-umbilical surgery under general anaesthesia and with a serratus-intercostal plane block [modified Blocking the bRanches of IntercostaL nerves in the Middle Axillary line (BRILMA)] as an associated analgesic strategy. Post-operative pain was assessed with the numerical verbal scale (NVS 0 to 10) on admission to the post-anAesthesia recovery unit, at 6, 12, 24, and 48h postintervention and by need for analgesic rescues with opioids (2mg iv of morphine, if values higher than 3 in NVS). Adverse events related to the technique were also recorded. The statistical package used in the analysis of the data was SPSS® for Windows. RESULTS The study recruited 52 patients. Differences, with a p<.05, were found intra-operatively in the consumption of fentanyl: 400 + 80μg versus 110 + 50μg in patients who underwent pre-incisional blockade. In the first 24hours, only 3 cases (two gastrectomies and one cholecystectomy) required morphine (single bolus of 2mg). Between 24h and 48h it was necessary to administer several morphine boluses (8 + 2mg) in four patients (three gastrectomies and one cholecystectomy). Four patients presented with nausea and / or vomiting and there were no complications related to the analgesic technique. CONCLUSION The intercostal nerves block (T7-T11) in the serratus-intercostal space may constitute an opioid-sparing analgesic strategy in open supra-umbilical surgery.
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Affiliation(s)
- M T Fernández Martín
- Servicio de Anestesiología y Reanimación, Hospital Medina del Campo, Valladolid, España.
| | - S López Álvarez
- Servicio de Anestesiología y Reanimación, Hospital Abente y Lago, A Coruña, España
| | - M A Pérez Herrero
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Ortiz de la Tabla González R, Gómez Reja P, Moreno Rey D, Pérez Naranjo C, Sánchez Martín I, Echevarría Moreno M. The usefulness of interpectoral block as an analgesic technique in breast cancer surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:188-195. [PMID: 29361312 DOI: 10.1016/j.redar.2017.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare the analgesic efficacy of continuous interpectoral block (CIPB) compared to intravenous analgesia (IV) after breast surgery. MATERIAL AND METHOD A prospective, comparative and randomised study of women aged from 18-75years, ASAI-III, operated for breast cancer. In group1 (CIPB) after general anaesthetic, an ultrasound-guided interpectoral catheter was placed and 30mL of 0.5% ropivacaine was administered through it. In the event of an increase in heart rate and blood pressure >15% after the surgical incision, intravenous fentanyl 1μg·kg-1 was administered, repeating the dose as necessary. In the postoperative period, perfusion of ropivacaine 0.2% 5mL·h-1; with PCA bolus 5mL/30minutes was administered through the catheter for 24hours and rescue analgesia prescribed with 5mg subcutaneous morphine chloride. In group2 (IV), after induction of general anaesthesia, intravenous fentanyl was administered in the same way as in the other group. The patients received metamizole 2g with dexketoprofen 50mg and ondansetron 4mg postoperatively followed by perfusion of metamizole 4%, tramadol 0.2% and ondansetron 0.08% 2ml·h-1; with PCA bolus 2mL/20min for 24hours. The same rescue analgesia was prescribed. The principal variables recorded were pain at rest and during movement, according to a simple verbal scale (VAS 0-10) and the rescue analgesia required on discharge from recovery, at 12 and at 24hours. RESULTS 137 patients were included: 81 in group1 (59.12%) and 56 in group2 (40.87%). No significant differences were observed in the analgesia between either group, but differences were observed in the dose of intraoperative fentanyl (P<.05). Differences that were not significant were observed in the rescue analgesia required on recovery (10% fewer on group1). CONCLUSIONS Both techniques provided effective postoperative analgesia, but the CIPB group required significantly less intraoperative fentanyl.
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Comparison of Ultrasonography-guided Bilateral Intercostal Nerve Blocks and Conventional Patient-controlled Intravenous Analgesia for Pain Control After the Nuss Procedure in Children: A Prospective Randomized Study. Clin J Pain 2018; 33:604-610. [PMID: 27841838 PMCID: PMC5462349 DOI: 10.1097/ajp.0000000000000449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: Patients experience severe pain after pectus excavatum (PE) surgery. The aim of this prospective, randomized study was to compare analgesic effects of ultrasonography-guided bilateral intercostal nerve blocks (UG-ICNBs) with those of conventional patient-controlled intravenous analgesia (PCIA) on acute pain after the Nuss procedure for PE repair in children. Methods: A prospective randomized study was performed in children with PE who were scheduled for the Nuss procedure. Participants were randomly assigned to receive either UG-ICNBs or PCIA for postoperative analgesia. Faces Pain Scale-Revised scores, opioid consumption, analgesia-associated side effects (respiratory depression, pruritus, nausea, vomiting) during the first 24 hours, and lengths of stay in the postanesthesia care unit (PACU) and hospital were recorded after the surgery. Results: Sixty-two children undergoing the Nuss procedure were enrolled in the trial. Faces Pain Scale-Revised scores were significantly decreased in the UG-ICNBs group compared with the PCIA group for up to 6 hours after surgery. The opioid doses required in the PACU and during the first 24 hours after surgery were significantly greater in the PCIA group compared with the UG-ICNBs group. Accordingly, patients in the UG-ICNBs group showed a lower incidence of analgesia-associated side effects and faster PACU discharge compared with the PCIA group. Conclusions: Our study suggests that UG-ICNBs might be more effective than PCIA for postoperative analgesia in children who undergo the Nuss procedure for PE.
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Fuzier R, Achelous S, Salvignol G, Jouve E. Hypnosis and Axillary Compartment Block for Breast Cancer Surgery: A Case Report. ACTA ACUST UNITED AC 2017; 9:81-83. [PMID: 28509780 DOI: 10.1213/xaa.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hypnosis has been proven to be a powerful tool in the management of anxiety and pain. It allows for an increase of pain threshold, which can reach the level of surgical analgesia. Recently injection of local anesthetics around the serratus muscle has been presented as an alternative to paravertebral block for cancer breast surgery. We report the successful use of hypnosis in combination with an axillary compartment block for lumpectomy and axillary lymph node dissection.
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Affiliation(s)
- Régis Fuzier
- From the Departments of *Anesthesiology; and †Surgery, Institut Claudius Regaud, IUCT-O, F-31059 Toulouse, France
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Gupta K, Srikanth K, Girdhar KK, Chan V. Analgesic efficacy of ultrasound-guided paravertebral block versus serratus plane block for modified radical mastectomy: A randomised, controlled trial. Indian J Anaesth 2017; 61:381-386. [PMID: 28584346 PMCID: PMC5444215 DOI: 10.4103/ija.ija_62_17] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Aims: Modified radical mastectomy (MRM) may be associated with severe post-operative pain, leading to chronic pain syndrome. We compared the post-operative analgesic profile of two ultrasound-guided nerve blocks: Paravertebral block (PVB) and serratus plane block (SPB). Methods: This double-blind, randomised study was conducted on fifty adult females, scheduled for MRM with axillary dissection. After inducing general anaesthesia with intravenous midazolam 1 mg, fentanyl 1.5 mcg/kg, propofol 1–2 mg/kg and vecuronium 0.1 mg/kg, patients were administered either ultrasound-guided thoracic PVB at T4 (n = 25) or SPB at 5th rib (n = 25) with 20 ml of 0.5% bupivacaine, both as a single level injection. Time to first rescue analgesia and morphine consumption in 4, 6, 24, 48 and 72 h by PCA pump, visual analogue scale score and any adverse effects were recorded. Quantitative variables were compared using the unpaired t-test or the Mann–Whitney U test between the two groups. Qualitative variables were compared using the Chi-square test or Fisher's exact test. Results: The duration of analgesia (mean ± Standard deviation [SD]) was significantly longer in the PVB group compared to SPB group (346 ± 57 min vs. 245.6 ± 58 min, P < 0.001). The post-operative 24 h morphine consumption (mean ± SD) was significantly higher in the SPB group (9.7 ± 2.1 mg) compared to PVB group (6.5 ± 1.5 mg) (P < 0.001). Conclusion: Ultrasound-guided SPB is an alternative analgesic technique to thoracic PVB for MRM although PVB provides a longer duration of analgesia.
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Affiliation(s)
- Kapil Gupta
- Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kadapa Srikanth
- Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kiran Kumar Girdhar
- Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vincent Chan
- Department of Anaesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Pérez Herrero MA, López Álvarez S, Fadrique Fuentes A, Manzano Lorefice F, Bartolomé Bartolomé C, González de Zárate J. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:564-571. [PMID: 27091641 DOI: 10.1016/j.redar.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The quality of postoperative recovery is one of the most important among all the quality indicators used in clinical situations. This is even more important after cancer surgery. Our aim was to evaluate this after non-reconstructive breast surgery under general anesthesia and paravertebral blockade or serratus-intercostal plane blockade, in the early and late post-operative period. MATERIAL AND METHODS A prospective observational study was conducted on 60 patients (25 paravertebral blockade group and 35 serratus-intercostal plane blockade group) scheduled for non-reconstructive breast surgery during a 6 month period. Every patient received general anaesthesia and were randomised to receive either paravertebral blockade or serratus-intercostal plane blockade. The quality of post-anaesthetic recovery was quantified by Postoperative Quality Recovery Scale, which is used to assess physiological, nociceptive, emotional, autonomy, cognitive and general state domains at different times: baseline (before surgery), 15min after the end of surgery, at discharge to home, and one month after surgery. RESULTS A total recovery of 95.93% was achieved in the early postoperative period (15min PACU), 99.07% at discharge to home, and 99.25% at one month after the intervention. No significant differences were found between groups in total score or in each evaluated area. CONCLUSIONS A progressive improvement was observed in the scores assessed with the Postoperative Quality Recovery Scale, reaching values that would allow the discharge to home and early return to usual active life from the immediate postoperative period, with no significant differences between the 2 analgesic techniques. Savings in opioid use and the excellent recovery were observed in all measured domains observed.
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Affiliation(s)
| | - S López Álvarez
- Complejo Hospitalario Universitario de A Coruña, A Coruña, España
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Diéguez P, Casas P, López S, Fajardo M. Ultrasound guided nerve block for breast surgery. ACTA ACUST UNITED AC 2016; 63:159-67. [PMID: 26776926 DOI: 10.1016/j.redar.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 12/17/2022]
Abstract
The breast surgery has undergone changes in recent years, encouraging new initiatives for the anaesthetic management of these patients in order to achieve maximum quality and rapid recovery. The fundamental tool that has allowed a significant improvement in the progress of regional anaesthesia for breast disease has been ultrasound, boosting the description and introduction into clinical practice of interfascial chest wall blocks, although the reference standard is still the paravertebral block. It is very likely that these blocks will change the protocols in the coming years. A review is presented of the anatomy of the breast region, description of nerve blocks and techniques, as well as their indications, all according to published articles and the opinion of the authors based on their experience.
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Affiliation(s)
- P Diéguez
- Servicio de Anestesiología, Hospital Abente y Lago, Complexo Hospitalario Universitario de A Coruña, A Coruña, España.
| | - P Casas
- Servicio de Anestesiología, Hospital Abente y Lago, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
| | - S López
- Servicio de Anestesiología, Hospital Abente y Lago, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
| | - M Fajardo
- Servicio de Anestesiología, Hospital Universitario de Móstoles, Madrid, España
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Fernández Martín MT, López Álvarez S, Mozo Herrera G, Platero Burgos JJ. [Ultrasound-guided cutaneous intercostal branches nerves block: A good analgesic alternative for gallbladder open surgery]. ACTA ACUST UNITED AC 2015; 62:580-4. [PMID: 25896736 DOI: 10.1016/j.redar.2015.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/26/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results.
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Affiliation(s)
- M T Fernández Martín
- Servicio de Anestesiología y Reanimación, Hospital Medina del Campo, Medina del Campo, Valladolid, España.
| | - S López Álvarez
- Servicio de Anestesiología y Reanimación, Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - G Mozo Herrera
- Servicio de Anestesiología y Reanimación, Hospital Medina del Campo, Medina del Campo, Valladolid, España
| | - J J Platero Burgos
- Servicio de Anestesiología y Reanimación, Hospital Medina del Campo, Medina del Campo, Valladolid, España
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Fajardo Pérez M, Alfaro de la Torre P, López Álvarez S, Diéguez García P. [Comments to the article "thoracic paravertebral block plus pectoral nerve block for mastectomy in a patient with advanced amyotrophic lateral sclerosis"]. ACTA ACUST UNITED AC 2013; 61:354-5. [PMID: 24144349 DOI: 10.1016/j.redar.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/11/2013] [Accepted: 09/04/2013] [Indexed: 11/19/2022]
Affiliation(s)
- M Fajardo Pérez
- Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Hospital del Tajo, Aranjuez, Madrid, España.
| | - P Alfaro de la Torre
- Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Hospital del Tajo, Aranjuez, Madrid, España
| | - S López Álvarez
- Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Complexo Universitario de A Coruña, A Coruña, España
| | - P Diéguez García
- Departamento de Anestesia, Reanimación y Tratamiento del Dolor, Complexo Universitario de A Coruña, A Coruña, España
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