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Review
. 2024 Feb 15;13(4):1104.
doi: 10.3390/jcm13041104.

Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review

Sascha Ott  1   2   3 , Lukas M Müller-Wirtz  1   4 , Gokhan Sertcakacilar  1   5 , Yasin Tire  1   6 , Alparslan Turan  1   7
Affiliations
Review

Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review

Sascha Ott et al. J Clin Med. .

Abstract

Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians' analgesic portfolios.

Keywords: ICU; abdominal wall blocks; airway blocks; chest wall blocks; peripheral nerve blocks; regional anesthesia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Pectoralis nerve block. (a) Transducer positioning. (b) Ultrasound anatomy of PECS I: PMmaj—pectoralis major muscle; PMmin—pectoralis minor muscle; red circle—pectoral branch of thoracoacromial artery; red line target space for PECS I block. (c) Spread of PECS I. (d) Spread of PECS II.
Figure 2
Figure 2
Serratus anterior plane block. (a) Transducer positioning. (b) Ultrasound anatomy of SAPB: LD—latissimus dorsi muscle; SA—serratus anterior muscle; IM—intercostal muscle; yellow line—pleura; red line—target space for SAPB. (c) Spread of SAPB.
Figure 3
Figure 3
Erector spinae plane block. (a) Transducer positioning. (b) Ultrasound anatomy of ESPB: ES—erector spinae muscle; TP—transverse process; red cross—target point for the injection at the edge of the TP; red line—target space for ESPB. (c) Frontal spread of ESPB. (d) Dorsal spread of ESPB.
Figure 4
Figure 4
Parasternal blocks. (a) Transducer positioning for PIFB. (b) Ultrasound anatomy of PIFB: PM—pectoralis muscle; IM—intercostal muscle; yellow line—pleura; red cross—target point for the injection at the edge of the rib; red line—target space for PIFB. (c) Spread of PIFB. (d) Transducer positioning for TTPB. (e) Ultrasound anatomy of TTPB: PM—pectoralis muscle; IM—intercostal muscle; TTM—transverse thoracic muscle; st—sternum; IMV—internal mammary vein; IMA—internal mammary artery; yellow line—pleura; red cross—target point for the injection between IM and TTM. (f) Spread of TTPB.
Figure 5
Figure 5
Transversus abdominis plane block. (a) Transducer positioning for TAPB. (b) Ultrasound anatomy of TAPB: EO—external oblique muscle; IO—internal oblique muscle; TA—transverse abdominal muscle; red line—target space for TAPB. (c) Spread of TAPB if applied bilaterally.
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