Vol 19, No 2 (2025)

Interfascial plane blocks have become widely used over the past decade. Their popularity is associated with relative simplicity of administration and a good analgesic effect. However, these techniques remain insufficiently studied both in terms of fundamental medical understanding and their clinical application. A search for available publications using relevant keywords in Russian and English was conducted in the PubMed, eLibrary, and CyberLeninka databases to evaluate analytically the theoretical aspects and clinical relevance of these anesthesia techniques. As of the end of 2024, a total of 1833 sources were identified in PubMed using the keyword phrase fascial block. In the Russian-language databases eLibrary and CyberLeninka, 276 articles were found using the keywords: фасциальные блокады (fascial blocks) and межфасциальные блокады (interfascial blocks). The first descriptions of block techniques and initial results in English appeared in the late 1990s; however, most publications, including those in Russian, have emerged within the past 9–10 years. Only a few articles are dedicated solely to the theoretical rationale of fascial plane blocks, whereas the predominant topic is their clinical application. A distinct concern is the limited amount of data on complications and adverse events associated with these regional anesthesia techniques. According to published findings, interfascial plane blocks are relatively easy to perform, offer effective analgesia and opioid-sparing benefits, and are associated with minimal side effects. Nevertheless, further research, including multicenter randomized trials, is required to better understand the clinical anatomy and physiology underlying interfascial plane blocks.

Peripheral nerve injury is defined as a condition diagnosed no earlier than 48 hours after regional block, manifesting as sensory and/or motor deficits in the innervation zone of the affected nerve, and confirmed by neurological examination. The incidence of transient neuropathy associated with peripheral nerve block is 2.2%, whereas persistent neurological deficit occurs in 2 to 4 cases per 10,000 blocks. Although postoperative nerve injury is rare, when such complications occur, they pose significant concerns for both the patient and the anesthesiologist.

The aim of this work was to summarize data from contemporary scientific publications on the prevention and management of peripheral nerve injuries associated with regional anesthesia. A search was conducted for the period from 2014 to 2024 using keywords in Russian and English: периферический нерв (peripheral nerve), повреждение (injury), регионарная анестезия (regional anesthesia), неврологические осложнения (neurological complications), профилактика повреждений нерва (nerve injury prevention) in the PubMed, eLibrary, and CyberLeninka databases. A total of 433 publications were identified, of which 383 were excluded for not addressing nerve injuries related to regional anesthesia. The remaining 50 publications formed the basis of this review. The review discusses the anatomy of peripheral nerves and the classification of nerve injuries, and provides detailed descriptions of mechanical, intraneural, ischemic, and neurotoxic mechanisms of nerve injury. Preventive techniques are described. It has been shown that the combined use of neurostimulation to identify the target nerves, ultrasound guidance to visualize the nerve, and injection pressure monitoring to avoid nerve injury is the key to safe regional anesthesia. The diagnostic assessment of nerve injury includes both assessment of clinical presentation and computed tomography and electrophysiological evaluations. A monitoring algorithm is presented for patients with suspected nerve injury following regional anesthesia. Management strategies for peripheral nerve injury are described in detail, including physiotherapy, pharmacotherapy, low-frequency electrical stimulation, low-intensity ultrasound, and phototherapy.

Intraoperative nerve injuries during regional block are rare and more often manifest as neurapraxia, which is transient and has a favorable prognosis. The combined use of neurostimulation, ultrasound navigation, and injection pressure monitoring ensures the safety and success of regional block. Treatment of nerve injuries requires a multidisciplinary approach. The development of Russian clinical guidelines for the prevention of nerve injuries during regional block will help anesthesiologists reduce the risk of complications.

BACKGROUND: Effective postoperative analgesia in thoracic surgery is essential for preventing complications such as atelectasis, pneumonia, and chronic pain. Despite the proven efficacy of paravertebral block (PVB), its use requires significant experience and carries certain risks. Erector spinae plane (ESP) block is considered a promising alternative; however, its effectiveness remains controversial, necessitating further comparative evaluation of these techniques.

AIM: The work is aimed to compare the analgesic efficacy of ESP block and PVB during and after video-assisted thoracoscopic atypical lung resection.

METHODS: A single-center, prospective, randomized, controlled trial was conducted in 45 patients aged 18–75 years (median age 63 [59; 69]) who underwent video-assisted thoracoscopic biopsy or atypical lung resection. Patients were randomized into two groups: ESP block group (n = 22) and PVB group (n = 23). The primary endpoints were pain intensity during intraoperative and postoperative periods (at rest and during coughing), and analysis of hemodynamic changes.

RESULTS: Anesthesia performance time was significantly shorter in the ESP group (p < 0.05). Pain intensity on the numeric rating scale was minimal in both groups during the first 3 hours after extubation. However, starting from hour 4 a statistically significant difference was observed, with a slight reduction in pain in the PVB group (p < 0.05). In the PVB group, pain scores during coughing remained lower throughout the 48-hour postoperative period. There was no significant difference between groups in fentanyl requirement (p = 0.72). Arterial hypotension requiring vasopressor support occurred more frequently in the PVB group. Despite the statistically significant differences, pain intensity did not exceed the score of 4 points on the numeric rating scale in either group over the 48-hour period.

CONCLUSION: During thoracoscopic interventions on the lungs in patients with cancer, the use of ESP block ensured a postoperative analgesic effect comparable to that of paravertebral block, accompanied by lower influence on hemodynamic indicators.

BACKGROUND: Articaine is widely used for infiltration and conduction anesthesia in dentistry; however, few studies have examined its use in regional blocks during limb surgeries.

AIM: The work aimed to compare the effectiveness of regional anesthesia with articaine versus ropivacaine in upper limb surgeries.

METHODS: A single-center, prospective, randomized study was conducted. It included 60 patients (all male), aged 35.2 ± 15.3 years, who underwent upper limb surgery under regional anesthesia. Patients were randomized into two groups: group 1 (n = 30) received 2% articaine, and group 2 (n = 30) received 0.5% ropivacaine. The groups were divided into subgroups (n = 15) based on the approach used: interscalene or axillary. The primary endpoint was the onset of sensory and motor block. Secondary endpoints included block duration and the incidence of adverse effects (nausea/vomiting, arterial hypotension, bradycardia, and dizziness).

RESULTS: When evaluating sensory block characteristics 30 minutes after anesthetic administration, statistically significant differences were observed only in the rate of block onset. In the articaine group, sensory block developed more rapidly with both the interscalene (group 1: 7.0 ± 2.9 min vs group 2: 10.0 ± 3.1 min [p = 0.015]) and axillary approaches (group 1: 8.0 ± 2.1 min vs group 2: 12.0 ± 4.2 min [p = 0.02]). Interscalene block resulted in complete shoulder immobility in 12 (80%) patients in group 1 and 13 (86.7%) in group 2. With axillary block, finger flexion was absent in 8 (53.3%) patients in group 1 and 9 (60%) in group 2 (p = 0.117). The block duration was longer in group 2 than in group 1, both for the interscalene approach (sensory: 12.1 ± 5.4 h vs 3.1 ± 0.5 h [p = 0.001]; motor: 5.3 ± 2.2 h vs 2.2 ± 0.8 h [p = 0.016]) and the axillary approach (sensory: 10.3 ± 3.2 h vs 2.8 ± 0.7 h [p = 0.001]; motor: 4.9 ± 1.4 h vs 1.7 ± 0.4 h [p = 0.02]). For complication rates, hoarseness was more frequently observed in the ropivacaine group (p = 0.03).

CONCLUSION: The quality and intensity of brachial plexus block using articaine is comparable to that of ropivacaine. Articaine block was characterized by a faster onset of sensory anesthesia and a shorter duration of both sensory and motor block compared with ropivacaine. For complication rates, hoarseness occurred less frequently in the articaine group.