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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.

Authors :
Ohgoshi Y
Anetai H
Hanai S
Ichimura K
Kawagoe I
Source :
Journal of anesthesia [J Anesth] 2024 Oct; Vol. 38 (5), pp. 642-649. Date of Electronic Publication: 2024 Jun 28.
Publication Year :
2024

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."<br />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.<br />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.<br />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.<br /> (© 2024. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Details

Language :
English
ISSN :
1438-8359
Volume :
38
Issue :
5
Database :
MEDLINE
Journal :
Journal of anesthesia
Publication Type :
Academic Journal
Accession number :
38940927
Full Text :
https://doi.org/10.1007/s00540-024-03366-w