Pain Research and Management

Biography

Biography: Jeff L. Xu

Abstract

Over the past 10 years, the introduction of ultrasound has rapidly changed the practice of regional anesthesia including the greater use of truncal nerve blocks. In the truncal block family, some of the blocks are performed just outside of neuraxial region, such as paravertebral nerve block (PVB) and lumbar plexus block, in addition to thoracolumbar interfascial plane (TLIP), retrolaminar block (RLB), erector spinae plane (ESP) block, and cervical columnar interfascial plane (CLIP) block, which are new techniques. These techniques are comparable to neuraxial nerve blocks in terms of success rate and analgesic efficacy and may confer many of advantages over neuraxial nerve blocks. Specifically, neuraxial blocks are not site-specific, they cause hypotension, and some of them may lead urinary retention, the placement of Foley catheters, limited mobility. Furthermore, neuraxial nerve block, such as epidural, was limited on patient who has spine fracture, spine instability, spine surgery or sepsis. Instead, paravertebral nerve block, most recently, has been performed more often clinically.  In addition, most of the truncal techniques can be performed in fully anesthetized patients, pronounced hypotension is unusual as sympathetic blocks are rarely bilateral, and urinary retention does not occur. We have proposed the use of the new terminology paraneuraxial nerve block. This new term provides a direct pictorial anatomy of the nerve block and would help clinicians develop clinical insights. This term has never been well-defined either anatomically or clinically. Anatomically, the paraneuraxial nerve is the spinal nerve between the lateral margin of the spinal foramen and the lateral edge of the erector spinae muscle. It contains the roots of the spinal nerve and its dorsal and ventral branches and their plexuses, white and gray rami communicantes, the sympathetic ganglion, and the sympathetic chain. The paraneuraxial nerve block family may include (but is not necessarily limited to) the PVB and the lumbar plexus nerve block, as well as ESP, RLB, TLIP block, CLIP block, sympathetic chain block. We believe that paraneuraxial nerve block will become even more popular clinically, due to its clinical and anatomical characteristics. It is thus clinically significant and beneficial in the practice, teaching, and training aspects of regional anesthesia. Study has shown that since 1990, wherein the relative percentage of spinal and epidural techniques has declined, and peripheral nerve blocks have increased. Paraneuraxial nerve blocks will challenge the clinical role of the traditional neuraxial nerve blocks fundamentally.