External oblique fascial plane block

• Published in: Regional anesthesia and pain medicine Vol. 44; no. 4; pp. 528 - 529
• Main Authors: Hamilton, Duncan Lee, Manickam, Baskar P, Wilson, Matthew A J, Abdel Meguid, Eiman
• Format: Journal Article
• Language: English
• Published: England Copyright by American Society of Regional Anesthesia and Pain Medicine 01.04.2019; BMJ Publishing Group LTD
• Subjects: Abdomen; Cadavers; Dissection; Ethics; Local anesthesia; Pain; Postoperative period; Regional anesthesia; Ultrasonic imaging; United Kingdom > UK; Australia; acute pain; anatomy; postoperative pain; truncal blocks
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2018-100256

Correspondence to Dr Duncan Lee Hamilton, Department of Anaesthesia, James Cook University Hospital, Middlesbrough TS4 3BW, UK; duncanleehamilton@nhs.net To the editor, We previously hypothesized that local anesthetic injected in a thoracic fascial plane might result in clinically useful analgesia of the anterolateral part of the upper abdominal wall.1 We are most grateful to Dr Wang and colleagues for sharing preliminary clinical confirmation of our theoretical premise.2 We have recently studied the spread of dye following injection in the thoracic fascial planes both deep and superficial to the external oblique muscle in a fresh frozen cadaver. [...]recent cadaveric and clinical studies on the serratus plane block have demonstrated inconsistent blockade of lateral cutaneous branches of the thoracoabdominal nerves below the T7 level, even with the use of high volumes (40 mL) of local anesthetic.3 A more posterior approach to the serratus plane near the inferior angle of scapula behind the posterior axillary line has shown blockade of the lateral cutaneous branches of the thoracoabdominal nerves below T8 level by extension of staining deep to the external oblique muscle.4 Hence, the external oblique plane could be a more suitable plane of injection for blockade of the anterior divisions of the lateral cutaneous branches of the thoracoabdominal nerves from T6 to T10, which is required for anterolateral upper abdominal wall analgesia. [...]the injection could be performed with the subject in the supine position, and the site is amenable to catheter insertion. Ethics approval Ethical approval for this study was granted by the Ethics Committee at Queen’s University Belfast, UK.