Gabriella Iohom | Chair Scientific Subcommittee on Regional Anaesthesia
Regional anaesthesia, a subspecialty relevant to most anaesthetists’ daily practice, encompasses both neuraxial and peripheral nerve blocks. Despite a clear trend towards more peripheral blocks, we are keen to maintain interest in both, to organise joint sessions with other subcommittees and therefore cater for a wide audience and a variety of learning tracks. With the advent of ultrasound guidance there is renewed interest in regional anaesthesia, explained by alleged improved success rates and fewer complications. However, a lot remains to be done in terms of acquisition of a new skill set by both existing specialists and novices in anaesthesia. This is just one example of a very exciting and rewarding area. Within the time constraints of each year, we strive to design a diverse scientific programme delivered by world class speakers who are experts in their field. We also organise the very well received, yearly hands-on Ultrasound Guided Regional Anaesthesia Workshop. This has recently been expanded to accommodate a greater number of participants and is delivered by expert groups in Europe on a rotational basis, as part of the main programme of each Euroanaesthesia meeting. In addition, Euroanaesthesia 2016 in London will see the second edition of a travelling pre-congress workshop dedicated exclusively to cadaveric anatomy.
The current composition of the subcommittee enjoys a balanced geographical representation. Clearly, interest in the advancement of the field of regional anaesthesia is the common denominator.
Gabriella Iohom is Consultant Anaesthetist and Senior Lecturer at Cork University Hospital and University College Cork in Ireland. Her interests include teaching and assessing procedural skills as well as the role of regional techniques in the management of postoperative pain and prevention of persistent post-surgical pain.
Alparslan Apan is Consultant Anaesthetist, Director of the Department, and Senior Lecturer at Giresun University Hospital and Medical School in Turkey. His main interests are teaching regional anaesthetic techniques and prevention of acute postoperative pain.
Jens Kessler is Specialist in Anaesthesia at University Hospital Heidelberg, Germany. A former recipient of the ESA’s ‘Young Teaching Recognition Award’, he is working on validating training tools for teaching ultrasound-guided regional anaesthesia. In addition, he is interested in applications of the technique in the field of Pain Medicine.
Philipp Lirk is Attending Anaesthesiologist at the Academic Medical Center/University of Amsterdam, The Netherlands. His research focuses on the pharmacology and toxicology of local anaesthetics and their application in Regional Anaesthesia.
Eric Albrecht is Attending Anaesthesiologist at the Lausanne University Hospital in Switzerland and is the Programme Director of Regional Anaesthesia. He is the main author of a French book on ultrasound-guided regional anaesthesia published by Elsevier-Masson. His field of research includes meta-analyses and prospective trials on acute postoperative pain, regional procedures, and complications after peripheral nerve blocks.
ESA Newsletter readers are encouraged to take an active part in the work of this subcommittee by
- applying to become a member or chair when a vacancy arises, or
- attending the pre-congress course and the main Regional Anaesthesiology Learning Track 3
- simply submitting a formal proposal to the ESA for a topic of discussion at one of the next Euroanaesthesia congresses.
We are all really looking forward to engaging with you!
Hot Topic in Regional Anaesthesia: Truncal Blocks
Alparslan Apan |Giresun University Faculty of Medicine, Giresun, Turkey
Perioperative pain remains a significant problem. Surgeries are increasingly evolving from inpatient to day-case interventions. Therefore, along with pain management, early ambulation and rehabilitation became an essential part of patient care. Shorter length of hospital stay means that patient satisfaction will increase and costs will decrease. The current concept of pain therapy is to reduce opioids and potential side effects related to these drugs. Similar changes are occurring in regional anaesthesia; the role of central neuraxial blocks, especially epidural anaesthesia, on postoperative pain is being reduced due to its side effects – prevention of mobilization and rare but potential serious complications.1 Contrary to this trend, after introduction of ultrasound guidance in regional anaesthesia, peripheral nerve block techniques are increasingly being preferred and performed. Similarly, using ultrasound guidance makes somatic nerve blocks more popular.
This year, at Euroanaesthesia 2016, we will focus on chest and abdominal wall.
Recent advances on commonly used techniques will be reviewed by experts. The first topic is the paravertebral block, which will be presented by Brian Kinirons from Galway University Hospital, Ireland. Prof. Kinirons is an expert on regional anaesthesia, has many publications in this field, and recently lectured on the same subject at the Congress of the African Society of Regional Anaesthesia. In comparison with epidural anaesthesia, paravertebral block seems to be superior in terms of ensuring hemodynamic stability. It can be accompanied by complications and side effects such as urinary retention, but with a lower incidence than in epidural anaesthesia.2 Prof. Kinirons’ lecture will cover the technique, patient selection, and recent advances in the literature.
Transversus abdominis plane (TAP) block, the second topic, will be presented by Prof. John McDonnell, also from Galway University Hospital, Ireland. Prof. McDonnell specialized in regional anaesthesia and has many publications, most of which address the TAP block. As a field block, classically TAP block is performed between the layers of abdominal muscles in the area known as Petit triangle.
Subcostal TAP block was also well defined in the literature. Recent findings indicate that posterior approach for the TAP block may provide wider distribution and more extended analgesia when compared to the anterior approach. The quadratus lumborum block, which may also be considered as a kind of TAP block, was demonstrated to decrease the pain on the abdominal wall for a longer period than observed in TAP block.3 In the light of current literature, Prof. McDonnell will discuss the indications and technical diversities of each kind of block.
The last topic is about a relatively new technique, pectoral nerve block, which will be presented by Prof. Xavier Sala-Blanch from University of Barcelona, Spain. Prof. Sala-Blanch is one of the experts in the field of ultrasound-guided regional anaesthesia. He performed many studies on this subject and has also presented invited lectures on the issue. Pectoral nerve blocks are performed between the layers of pectoral muscles.4 Prof. Sala-Blanch will explain these techniques, as well as indications and recent advances in the literature.
Obviously, technical advancements may improve the quality of blocks and increase their safety. The use of ultrasound devices may induce new techniques in regional anaesthesia. International meetings are one of the ways to learn, practice, and discuss the novelties. We expect that all participants will benefit from the sessions and receive take-home messages.