Department of Anesthesia and Cardiac Surgery Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy -
Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy.
Minerva Anestesiol. 2021 Dec;87(12):1338-1346. doi: 10.23736/S0375-9393.21.15599-3. Epub 2021 Oct 11.
Fascial plane blocks represent anesthetic procedures performed to manage perioperative and chronic pain. Recently, many fascial blocks techniques have been described increasing their field of applications. They offer anesthetic and analgesic efficacy, easy of execution and low risk of complications. The newest techniques recently described are the ultrasound parasternal blocks (US-PSB) which provide analgesia to the antero-medial chest wall. In particular, the antero-medial chest wall blocks are performed to provide analgesia and anesthesia in several and different surgeries such as median sternotomy, breast surgery, implantable cardioverter-defibrillator implantation and in the management of acute and chronic pain. The nervous target for these blocks is represented by the anterior branches of the intercostal nerves which enter the intercostal (ICM) and pectoralis major (PMM) muscles innervating the antero-medial region of chest wall, the main cause of poststernotomy pain. Local anesthetic is injected deep to PMM and superficial to the ICM or between the internal thoracic muscle (IIM) and transversus thoracis muscle (TTM). So, essentially these blocks may be described as superficial or deep parasternal-intercostal plane blocks, based on where the target nerves are hunted. Even if they all provide analgesia to the antero-medial chest wall, the anatomical injection site represents the main peculiarity that differentiates these techniques. To date, a common nomenclature for antero-medial chest wall blocks or parasternal-intercostal plane blocks is not yet well defined and a standardized nomenclature is needed to ensure an adequate communication among anesthesiologists.
筋膜平面阻滞是一种用于围术期和慢性疼痛管理的麻醉操作。最近，许多筋膜阻滞技术已经被描述，增加了其应用领域。它们具有麻醉和镇痛效果，易于实施，且并发症风险低。最近描述的最新技术是超声胸骨旁阻滞（US-PSB），它可以为前内侧胸壁提供镇痛。特别是，前内侧胸壁阻滞可用于提供多种不同手术的镇痛和麻醉，如正中开胸术、乳房手术、植入式心脏复律除颤器植入术以及急性和慢性疼痛的管理。这些阻滞的神经靶点是肋间神经的前支，它们进入肋间肌（ICM）和胸大肌（PMM），支配胸壁的前内侧区域，是胸骨切开术后疼痛的主要原因。局部麻醉药被注入胸大肌深部和肋间肌浅部之间，或胸内肌（IIM）和胸横肌（TTM）之间。因此，这些阻滞基本上可以被描述为浅层或深层胸骨旁肋间平面阻滞，这取决于目标神经的位置。尽管它们都可以为前内侧胸壁提供镇痛，但解剖学注射部位是区分这些技术的主要特征。迄今为止，前内侧胸壁阻滞或胸骨旁肋间平面阻滞的通用命名法尚未得到很好的定义，需要标准化的命名法以确保麻醉师之间进行充分的沟通。
