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Acta clinica Croatica, Vol. 61. No. Supplement 2, 2022.

Professional paper

https://doi.org/10.20471/acc.2022.61.s2.18

New Concept of Fusion Technics in Regional Anesthesia

Lada Kalagac Fabris orcid id orcid.org/0000-0001-8645-2128 ; Department of Anesthesiology, Intensive Medicine and Pain Therapy General Hospital Pula, Pula, Croatia
Maša Biberić ; Department of Anesthesiology, Intensive Medicine and Pain Therapy General Hospital Pula, Pula, Croatia
Siniša Zrna orcid id orcid.org/0000-0002-6023-3530 ; Department of Anesthesiology, Intensive Medicine and Pain Therapy General Hospital Pula, Pula, Croatia

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Abstract

The aim of this review article is to introduce a newer approach to multimodal anesthesia.
In addition to the usual combination of epidural catheter and general anesthesia as standard
techniques in surgical procedures accompanied by intense postoperative pain, we want to encourage
reflection on the application of various regional techniques in equally complex surgical conditions. By
simply modifying the standard neuraxial technique with a higher thoracic approach, excellent abdominal
surgery can be performed to awake the patient. However, placement of an epidural catheter is not
always possible due to technical difficulties or patient-related conditions that contraindicate its insertion.
Trunk-level fascia blocks (PVB, ESPB, RLB) are simple, safe alternative to an epidural catheter
because the transverse process, which is the target of ultrasound, is easily visualized and the injection
site is away from neuroaxis, pleura, and large vascular structures. In addition, extensive craniocaudal
diffusion of anesthetics allows wide coverage with a single injection. It has been confirmed that
PVB, ESPB, RLB blocks act on visceral and somatic pain. Therefore, their ultrasound-guided use in
laparoscopic and other abdominal surgeries may be useful. With a well-designed fusion of regional
techniques in operations of the upper and lower abdomen, it is possible to achieve hemodynamically
and respiratory stable anesthesia in an awake patient with reduced postoperative pain.

Keywords

Spinal; Epidural; US guided block; PVB; ESP; RLB

Hrčak ID:

284412

URI

https://hrcak.srce.hr/284412

Publication date:

1.9.2022.

Article data in other languages: croatian

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