Clinical implications of intermuscular spaces in fascial plane anesthesia in the thoracic and abdominal regions

Abstract

Introduction. Over the years the accumulated knowledge about cellular spaces and fascicles began to be used in anesthesiologic practice on an increasingly large scale. By knowing the area of innervation in the surgical region, it was possible to inject local anesthetic into a cell space near the operative procedure. Localization of the interfascial space on external landmarks alone is mostly uncertain. This is why the advent of ultrasound with live, real-time visualization of anatomy has revolutionized both medical diagnosis and the technique of loco-regional anesthesia. Material and methods Primary scientific studies and practical textbooks published from 1951 to 2023 dedicated to loco-regional anesthesia techniques were studied. To achieve the proposed goal, scientific sources PubMed, Medscape, SCOPUS, MEDLINE were researched. Key words used for searching are fascia plane anesthesia, clinical anatomy, thoracic and abdominal plane blocks. More than 300 reference sources were identified, but less than 30 were selected for analysis. Results and discussions There has been a vertiginous development of techniques to block the subfascial spaces. Compared to neuroaxial anesthesia, fascial plane block has certain advantages: simplicity of performance, fewer complications and comparable analgesia. Thanks to recent research worldwide using ultrasonography, the concept of fascial interconnectivity has been demonstrated, which is fundamental in understanding the effects and complications of fascial plane block. This minimized the number of immediate complications and led to a significant increase in interest in the use of peripheral nerve blocks. Conclusions One of the goals of the study of topographic anatomy is to perform medical-surgical manoeuvres, followed by as few complications as possible. Thus, for several years, fascial plane blocks have switched from techniques based on anatomic landmarks to ultrasonographic guidance. Being at the beginning of the path, their value is increasing, for research and further knowledge, both in the field of topographic anatomy in vivo and in the applied and practical fields, especially in anesthesiology.