From Nerves to Fascial Planes: The Changing Paradigm of Regional Anaesthesia

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Vol 6 | Issue 2 | July-December 2025 | Page 01 | Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Authors: Sandeep Diwan [1]

[1] Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Sandeep Diwan,
Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
Email ID: sdiwan14@gmail.com

Editorial

Regional anaesthesia has always been a story of continuous evolution. We moved from anatomical landmarks to nerve stimulation, and then to ultrasound, each advance bringing greater precision and safety. Today, however, we find ourselves at another turning point. The excitement is no longer just about introducing another block; it is about understanding why blocks work and how anatomy, fascial planes, and injectate behaviour shape clinical outcomes.
The articles in this issue of the International Journal of Regional Anaesthesia beautifully reflect this evolution. The discussions on the Para-Iliopsoas (PIP) block, Modified Thoracoabdominal Plane Block (M-TAPA), and External Oblique Intercostal Plane Block (EOIPB) remind us that regional anaesthesia is gradually shifting from a nerve-centric specialty to one that is increasingly anatomy-driven.
For many years, success meant placing local anaesthetic as close as possible to a named nerve. Fascial plane blocks have challenged that traditional thinking. They have taught us that tissue planes, anatomical continuity, and the behaviour of injectate are equally important. The question we now ask is no longer simply, Which nerve am I blocking? Instead, we ask, Which anatomical pathway am I influencing? That subtle change in perspective has opened new possibilities in both research and clinical practice.
The newer techniques featured in this issue should therefore not be viewed merely as additions to an already long list of blocks. Rather, they represent refinements in our understanding of anatomy. Whether targeting the iliopsoas compartment, the perichondrial plane, or the external oblique intercostal interface, each technique seeks to improve analgesia while minimizing motor blockade and unnecessary tissue disruption.
Equally refreshing is the balanced scientific approach adopted by the authors. They acknowledge that the available evidence is still evolving, with limitations such as small sample sizes, heterogeneous methodologies, and variable sensory mapping. Such honesty strengthens the science. Innovation should stimulate curiosity, but it is rigorous evidence that ultimately determines whether a technique earns its place in everyday clinical practice.
Another striking feature of contemporary regional anaesthesia is the growing partnership between cadaveric research and clinical investigation. Cadaveric dissections, combined with CT imaging and meticulous anatomical studies, are helping us visualize injectate spread and better understand why certain techniques succeed while others produce variable results. These studies are steadily narrowing the gap between anatomical theory and bedside practice.
Ultrasound has also matured beyond being simply a tool for locating nerves. It now allows us to appreciate anatomy as a dynamic, three-dimensional system. Success depends not only on identifying structures but also on recognizing fascial planes, hydrodissection, needle trajectory, and real-time injectate spread. Precision today lies as much in understanding anatomy as in technical skill.
Looking ahead, the future of regional anaesthesia is likely to extend well beyond new block descriptions. Artificial intelligence, advanced imaging, computational modelling of injectate spread, and personalized analgesic strategies promise to further transform our practice. As our understanding grows, regional anaesthesia is evolving from a procedural discipline into a comprehensive science of precision perioperative pain management.
As the official journal of AORA, IJRA has an important responsibility in this journey. Our role is not simply to publish new techniques but to encourage thoughtful debate, robust anatomical research, and high-quality clinical evidence. Progress in regional anaesthesia will ultimately be measured not by the number of blocks we describe, but by how well we understand anatomy, critically evaluate evidence, and translate both into safer, more effective care for our patients.
Sandeep Diwan
Editor IJRA

How to Cite this Article: Diwan S. From Nerves to Fascial Planes: The Changing Paradigm of Regional Anaesthesia. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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Erector Spinae Plane Block with Ultrasound- and CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report

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Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Nazia Nazir , Bhumika Gautam , Shivi Mishra , Samiksha Khanuja , Savita Gupta

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 20-07-2025; Reviewed: 15-08-2025; Accepted: 17-10-2024; Published: 10-12-2025

Authors: Nazia Nazir [1], Bhumika Gautam [1], Shivi Mishra [1], Samiksha Khanuja [1], Savita Gupta [1]

[1] Department of Anesthesiology and Critical Care Government Institute of Medical Sciences, Greater Noida, UP, India.

Address of Correspondence

Dr. Nazia Nazir,
Department of Anesthesiology and Critical CareGovernment Institute of Medical Sciences, Greater Noida, UP, India.
E-mail: nazunazir@gmail.com

Abstract

Background: Excision of giant pulmonary hydatid cysts carries high risks of cyst rupture, anaphylaxis, and respiratory compromise, necessitating precise lung isolation and robust regional analgesia.
Case Description: A 35-year-old female presented for posterolateral thoracotomy to excise a giant pulmonary hydatid cyst. The primary anesthetic goals were to ensure atraumatic lung isolation and minimize postoperative pulmonary complications.
Intervention: A multimodal approach was utilized: airway ultrasound and CT imaging were combined to precisely select a left-sided double-lumen tube (DLT). For analgesia, an ultrasound-guided erector spinae plane (ESP) block was administered preoperatively to facilitate an opioid-sparing technique.
Outcome: The strategy resulted in effective lung isolation, excellent intraoperative stability, and superior postoperative pain control. The patient was extubated early, demonstrated improved respiratory mechanics, and achieved an uneventful recovery with minimal opioid requirements.
Conclusion: Combining image-guided airway assessment with the ESP block provides a safe, effective, and comprehensive anesthetic strategy for high-risk thoracic procedures.
Keywords: Airway ultrasound, Double-lumen tube sizing, Erector spinae plane block, Thoracotomy analgesia, Pulmonary hydatid cyst, One-lung ventilation

References

1. Al-Hurani M, Al-Hadrab Y, Ayoub KR, Al-Salhi A, Al-Sarsour HS, Kocher GJ. Thoracoscopic Approach for Treating a Primary Hydatid Cyst in the Thymus in a Teenager: A Case Report. Am J Case Rep. 2025; 22;26: e948600.
2. Sachar S, Goyal S, Goyal S, Sangwan S. Uncommon locations and presentations of hydatid cyst. Ann Med Health Sci Res. 2014;4(3):447-52.
3. Pokhriyal, Abhimanyu Singh; Tomar, Sonu; Saran, Vinayak. Anesthetic management of the patient with large pulmonary hydatid cyst: A case report. Bali Journal of Anesthesiology 2024;8(1): 53-6
4. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane blocks in thoracic surgery. Anaesthesia. 2017;72(4):452–460.
5. Mathew RM, Gautam S, Raman R, Rai A, Srivastava VK, Singh MK. Evaluating the precision of ultrasound versus computed tomography-guided measurement of cricoid cartilage diameter for double-lumen tube selection in thoracic surgery: A randomised comparative study. Indian J Anaesth. 2024; 68(10):896-901.
6. Brodsky JB, Lemmens HJ. Left double-lumen tube size selection: A practical method.
Anesth Analg. 2005;100(3):853–856.
7. Pooja Chandran, Ankit Agarwal, Debendra K Tripathy, Nitish Thakur, Vikram Chandra. Anaesthetic Considerations in Simultaneous Management of Pulmonary and Hepatic Ruptured Hydatid Cyst: A Case Report. Archives of Anesthesiology and Critical Care 2023; 9(3): 265-267.
8. Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy. Ann Transl Med. 2019;7(8):174.

How to Cite this Article: Nazir N, Gautam B, Mishra S, Khanuja S, Gupta S. Erector Spinae Plane Block with Ultrasoundand CT-Based Double-Lumen Tube Selection for Thoracotomy in Giant Pulmonary Hydatid Cyst: A Case Report. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report

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Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Sreyashi Naskar , K R Chandrakala , Soumya Nayak

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 01-06-2025; Reviewed: 29-06-2025; Accepted: 13-11-2025; Published: 10-12-2025

Authors: Sreyashi Naskar [1], K R Chandrakala [1], Soumya Nayak [1]

[1] Department of Paediatric Anaesthesiology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.

Address of Correspondence

Dr. Sreyashi Naskar,
Department of Paediatric Anaesthesiology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka. India
E-mail id: sreyashi.n@gmail.com

Abstract

Mucopolysaccharidosis (MPS) is an inherited lysosomal storage disorder where glycosaminoglycans accumulate in various connective tissues, resulting into a myriad of organ system abnormalities. One of the most challenging aspect of their anaesthesia management is airway control, as these are almost always deemed difficult airway subjects. Anaesthetising neonates or small infants with MPS proves to be an even more critical scenario due to their added airway and respiratory physiological characteristics. Conducting surgeries on such patients under sole regional/ neuraxial anaesthesia can be an extremely efficacious and safe approach, provided the difficulties in their neuraxial anatomy are kept in mind, and thereof, managed accordingly. However, sole neuraxial anaesthesia in small children with MPS is scantly reported in existing literature and hence needs further reporting and study.
Keywords: Mucopolysaccharidoses, Mucopolysaccharidosis III, Obstructive Sleep Apneas, Dwarfism, Airway management

References

1. Valstar MJ, Ruijter GJ, van Diggelen OP, Poorthuis BJ, Wijburg FA. Sanfilippo syndrome: a mini-review. J Inherit Metab Dis. 2008;31(2):240-252. doi:10.1007/s10545-008-0838-5
2. Clark BM, Sprung J, Weingarten TN, Warner ME. Anesthesia for patients with mucopolysaccharidoses: Comprehensive review of the literature with emphasis on airway management. Bosn J Basic Med Sci. 2018;18(1):1-7. Published 2018 Feb 20. doi:10.17305/bjbms.2017.2201
3. Frawley G, Fuenzalida D, Donath S, Yaplito-Lee J, Peters H. A retrospective audit of anesthetic techniques and complications in children with mucopolysaccharidoses. Paediatr Anaesth. 2012;22(8):737-744. doi:10.1111/j.1460-9592.2012.03825.x
4. Megens JH, de Wit M, van Hasselt PM, Boelens JJ, van der Werff DB, de Graaff JC. Perioperative complications in patients diagnosed with mucopolysaccharidosis and the impact of enzyme replacement therapy followed by hematopoietic stem cell transplantation at early age. Paediatr Anaesth. 2014;24(5):521-527. doi:10.1111/pan.12370
5. Walker R, Belani KG, Braunlin EA, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36(2):211-219. doi:10.1007/s10545-012-9563-1
6. Theroux MC, Nerker T, Ditro C, Mackenzie WG. Anesthetic care and perioperative complications of children with Morquio syndrome. Paediatr Anaesth. 2012;22(9):901-907. doi:10.1111/j.1460-9592.2012.03904.x
7. Kempthorne PM, Brown TC. Anaesthesia and the mucopolysaccharidoses: a survey of techniques and problems. Anaesth Intensive Care. 1983;11(3):203-207. doi:10.1177/0310057X8301100304
8. Cingi EC, Beebe DS, Whitley CB, Belani KG. Anesthetic care and perioperative complications in children with Sanfilipo Syndrome Type A. Paediatr Anaesth. 2016;26(5):531-538. doi:10.1111/pan.12876
9. Cade J, Jansen N. Anesthetic Challenges in an Adult with Mucopolysaccharidosis Type VI. A A Case Rep. 2014;2(12):152-154. doi:10.1213/XAA.0000000000000031
10. Vas L, Naregal F. Failed epidural anaesthesia in a patient with Hurler’s disease. Paediatr Anaesth. 2000;10:95-98
11. Berkowitz ID, Raja SN, Bender KS, Kopits SE. Dwarfs: pathophysiology and anesthetic implications. Anesthesiology. 1990;73(4):739-759.
12. Dr Andrew O’Donoghue, Dr James Isherwood, Dr Brıd McGrath. Anaesthesia for Paediatric Patients with Achondroplastic short stature. ATOTW 476. Published July 19, 2022.

How to Cite this Article: Naskar S, Chandrakala KR, Nayak S. Spinal Anaesthesia for Inguinal Herniotomy in an Infant with Mucopolysaccharidosis type III with skeletal dwarfism: A Case Report. International Journal of Regional Anaesthesia | July-December 2025; 6(2): 00-00 | DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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External Oblique Intercostal Plane Block

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Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Rashmi Syal

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 09-09-2025; Reviewed: 05-10-2025; Accepted: 17-11-2025; Published: 10-12-2025

Authors: Rashmi Syal [1]

[1] Department of Anaesthesia, Dr. S.N Medical College, Jodhpur, Rajasthan, India.

Address of Correspondence

Dr. Rashmi Syal,
Department of Anaesthesia, Dr. S.N Medical College, Jodhpur, Rajasthan, India.
Email: rashmisyal2006@gmail.com

Abstract

External plane fascial plane block is a newer block that targets lateral cutaneous and anterior cutaneous divisions of the thoracoabdominal intercostal nerves. The intended site of injection is the interfacial plane deep to the external oblique muscle and superficial to the underlying intercostal musculature, which extends longitudinally along the anterolateral thoracoabdominal wall. At the level of the sixth rib, a high-frequency linear ultrasound transducer is placed in the sagittal plane between the midclavicular and anterior axillary lines, with the orientation marker directed cranially. The needle is then advanced in-plane from a superomedial-to-inferolateral direction, with the skin entry point just medial to the anterior axillary line at a level cranial to the sixth rib.
Keywords: External oblique intercostal plane, Thoracoabdominal intercostal nerves, Local anaesthetic

References

1. Hamilton DL, Manickam BP, Wilson MAJ, Abdel Meguid E. External oblique fascial plane block. Reg Anesth Pain Med. 2019;rapm-2018-100256. doi:10.1136/rapm-2018-100256.
2. Elsharkawy H, Kolli S, Soliman LM, Seif J, Drake RL, Mariano ER, et al. The external oblique intercostal block: anatomic evaluation and case series. Pain Med. 2021;22:2436–42.
3. White L, Ji A. External oblique intercostal plane block for upper abdominal surgery: use in obese patients. Br J Anaesth. 2022;128:e295–7.
4. Elsharkawy H, Maniker R, Bolash R, et al. Rhomboid intercostal and subserratus plane block: a cadaveric and clinical evaluation. Reg Anesth Pain Med. 2018;43(7):745–51.
5. Miyawaki M. Constancy and characteristics of the anterior cutaneous branch of the first intercostal nerve: correcting the descriptions in human anatomy texts. Anat Sci Int. 2006;81(4):225–41.
6. Thakore S, Mistry T, Nair AS, Kaasat A. External oblique intercostal plane block: a scoping review of anatomy, techniques, and clinical applications. Indian J Anaesth. 2026;70:157–76.
7. Saran A, Hoda W, Pandey K, Mahendru K, Kumar A, Sarma R. External oblique intercostal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized controlled trials. Indian J Anaesth. 2026;70:27–40.
8. Ozel ES, Kaya C, Turunc E, Ustun YB, Cebeci H, Dost B. Analgesic efficacy of the external oblique intercostal fascial plane block on postoperative acute pain in laparoscopic sleeve gastrectomy: a randomized controlled trial. Korean J Anesthesiol. 2025;78:159–70.
9. Cosarcan SK, Ercelen O. The analgesic contribution of external oblique intercostal block: case reports of 3 different surgeries and 3 spectacular effects. Medicine (Baltimore). 2022;101:e30435.
10. Cosarcan SK, Yavuz Y, Dogan AT, et al. Can postoperative pain be prevented in bariatric surgery? Efficacy and usability of fascial plane blocks: a retrospective clinical study. Obes Surg.2022;32:2921–9.

How to Cite this Article: Syal R. External Oblique Intercostal Plane Block. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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Para-Iliopsoas Block: Anatomical Rationale, Technique, and Contemporary Clinical Perspective

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Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Kirtika Yadav, Neel Kamal Mishra, Prem Raj Singh

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 11-08-2025; Reviewed: 09-09-2025; Accepted: 21-11-2025; Published: 10-12-2025

Authors: Kirtika Yadav [1], Neel Kamal Mishra [1], Prem Raj Singh [1]

[1] Department of Anaesthesiology, King George’s Medical University, Lucknow, U.P., India.

Address of Correspondence

Dr. Prem Raj Singh,
Department of Anaesthesiology, King George’s Medical University, Lucknow, U.P. India.
E-mail: dr.p.rajsingh@gmail.com

Abstract

The para-iliopsoas (PIP) plane block is a novel regional anaesthesia technique developed to enhance analgesia for hip and proximal thigh surgeries. By targeting the fascial plane between the iliopsoas complex and fascia iliaca at the level of the anterior superior iliac spine, the PIP block facilitates deposition of local anaesthetic near the lumbosacral trunk. This approach aims to achieve reliable blockade of the femoral nerve, lateral femoral cutaneous nerve, and potentially the obturator nerve, thereby improving hip joint analgesia while minimizing quadriceps weakness. Ultrasound guidance enables precise needle placement and visualization of spread, with volumes of 20–30 ml required to overcome fascial resistance and promote longitudinal distribution. Clinical applications include total hip arthroplasty, hip arthroscopy, femoral neck fractures, and anterior thigh procedures, with reported benefits of reduced opioid consumption and improved patient positioning for neuraxial anaesthesia. However, limitations include variable obturator coverage, anatomical variability, and risks of peritoneal or vascular injury with deep needle advancement. Current evidence is limited to cadaveric, imaging, and small clinical series, underscoring the need for further validation. The PIP block holds promise as part of multimodal, opioid-sparing analgesia strategies in hip surgery.
Keywords: Regional anaesthesia, Fascial plane blocks, Hip surgery

References

1. Sharma SK, Sonawane K, Mistry T. A narrative review on fascial plane blocks–Part A: Anatomical foundations and mechanistic insights. Indian Journal of Anaesthesia. 2026 Jan 1;70(1):127-36. https://doi.org/10.4103/ija.ija_1553_25
2. Saini T, Aggarwal M, Singh U, Singh MR. Pericapsular nerve group (PENG) block versus supra-inguinal fascia iliaca (SIFI) block for functional outcome in patients undergoing hip surgeries–A randomised controlled study. Indian Journal of Anaesthesia. 2024 Dec 1;68(12):1043-8. https://doi.org/10.4103/ija.ija_838_24
3. Diwan S, Nair A, Gawai N, Shah D, Sancheti P. Circumpsoas block–an anterior myofascial plane block for lumbar plexus elements: case report. Brazilian Journal of Anesthesiology. 2023 Oct 23;73(5):689-94. https://doi.org/10.1016/j.bjane.2021.04.015
4. Hu J, Wang Q, Hu J, Gong C, Yang J. Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: a prospective, double-blind, placebo-controlled study. Anaesthesia Critical Care & Pain Medicine. 2023 Dec 1;42(6):101282. https://doi.org/10.1016/j.accpm.2023.101282
5. Ghimire A, Kalsotra S, Tobias JD, Veneziano G. Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review. Saudi Journal of Anaesthesia. 2025 Jan 1;19(1):65-76. https://doi.org/10.4103/sja.sja_467_24
6. Almeida CR. The novel proximal para-iliopsoas (PPIP) block for hip surgery: a technical report. Indian journal of anaesthesia. 2022 Dec 1;66(12):885-6.
https://doi.org/10.4103/ija.ija_735_22
7. Lastoria DA, Halicka Z, Liu KC, Bonsu EO, Reaveley M, Parry D. Fascia iliaca blocks: a cadaveric study comparing the suprainguinal approach to the loss of resistance technique. Cureus. 2023 Apr 28;15(4):e38243. https://doi.org/10.7759/cureus.38243
8. Vermeylen K, Desmet M, Leunen I, Soetens F, Neyrinck A, Carens D, Caerts B, Seynaeve P, Hadzic A, Van de Velde M. Supra-inguinal injection for fascia iliaca compartment block results in more consistent spread towards the lumbar plexus than an infra-inguinal injection: a volunteer study. Regional Anesthesia & Pain Medicine. 2019 Apr 1;44(4):483-91. https://doi.org/10.1136/rapm-2018-100092
9. Jiang BW, Guo Y, Han YN, Bai YH, Chen X, Zhao KF, Liu YB, Wang CG. Iliopsoas plane block versus femoral nerve block for postoperative quality of recovery following hip arthroplasty: a randomized controlled trial. Scientific Reports. 2025 May 5;15(1):15723. https://doi.org/10.1038/s41598-025-00978-4
10. O’reilly N, Desmet M, Kearns R. Fascia iliaca compartment block. BJA education. 2019 Jun 1;19(6):191-7. https://doi.org/10.1016/j.bjae.2019.03.001
11. Yeoh SR, Chou Y, Chan SM, Hou JD, Lin JA. Pericapsular Nerve Group Block and Iliopsoas Plane Block: A Scoping Review of Quadriceps Weakness after Two Proclaimed Motor-Sparing Hip Blocks. Healthcare (Basel). 2022 Aug 18;10(8):1565. https://doi.org/10.3390/healthcare10081565

How to Cite this Article: Yadav K, Mishra NK, Singh PR. Para-Iliopsoas Block: Anatomical Rationale, Technique, and Contemporary Clinical Perspective. International Journal of Regional Anaesthesia. July-December 2025; 6(1): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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Modified Thoracoabdominal Plane Block (M-TAPA): Narrative Technical Review

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Vol 6 | Issue 2 | July-December 2025 | Page 00-00 | Shilpa Bhat

DOI: https://doi.org/10.13107/ijra.2025.v06.i02.000

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 07-09-2025; Reviewed: 28-09-2025; Accepted: 23-11-2025; Published: 10-12-2025

Authors: Shilpa Bhat [1]

[1] Department of Anaesthesia, Yenepoya Medical College, Mangaluru, Karnataka, India.

Address of Correspondence

Dr. Shilpa Bhat,
Department of Anaesthesia, Yenepoya Medical College, Mangaluru, Karnataka, India.
Email ID: shilpabhat04@gmail.com

Abstract

The modified thoracoabdominal plane block through a perichondrial approach (M-TAPA) is an emerging ultrasound-guided fascial plane technique developed to improve analgesia for upper abdominal surgery. This narrative technical review summarizes current anatomical concepts, procedural technique, injectate spread, clinical applications, and available evidence. Relevant anatomical, cadaveric, ultrasound, and clinical studies were critically reviewed to provide a practical overview. Available data indicate that M-TAPA predominantly provides anterior abdominal wall analgesia with preferential involvement of anterior cutaneous branches and may reduce postoperative pain and opioid requirements in selected procedures. Dermatomal spread, however, remains variable and appears to depend more on fascial anatomy, probe positioning, and accurate perichondrial plane identification than on injectate volume alone. Existing literature is limited by small sample sizes and heterogeneity in methodology, limiting direct comparisons with established fascial plane blocks. Overall, M-TAPA represents an anatomy-driven refinement with promising clinical utility when performed using meticulous ultrasound guidance and sound anatomical principles.
M-TAPA is a promising ultrasound guided fascial plane block that offers targeted anterior abdominal wall analgesia. Further high-quality comparative studies are needed to define its optimal indications, reproducibility, and role in contemporary perioperative pain management.
Keywords: Modified thoracoabdominal plane block, M-TAPA, Ultrasound-guided fascial plane block, Abdominal wall analgesia, Perioperative pain management.

References

1. Hebbard P. Transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35(4):616-7.
2. Tulgar S, Senturk O, Selvi O, et al. Ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach (M-TAPA): a cadaveric and clinical evaluation. J Clin Anesth. 2019;55:81-2.
3. Ahiskalioglu A, Tulgar S, Celik M, et al. Spread of dye in modified thoracoabdominal nerves block through perichondrial approach in a cadaveric study. Surg Radiol Anat. 2020;42(4):469-75.
4. Børglum J, Jensen K. Abdominal wall blocks in adults. Curr Opin Anaesthesiol. 2018;31(5):638-43.
5. Sondekoppam RV, Tsui BCH. Factors influencing the spread of local anesthetic in fascial plane blocks. Curr Opin Anaesthesiol. 2021;34(5):638-44.
6. Chin KJ, Mariano ER, El-Boghdadly K. Ultrasound-guided fascial plane blocks of the chest and abdominal wall: a state-of-the-art review. Anaesthesia. 2021;76(S1):110-26.
7. De Cassai A, Bonvicini D, Correale C, et al. Spread of injectate in abdominal fascial plane blocks. Minerva Anestesiol. 2021;87(3):295-302.
8. Ökmen K, Metin Ökmen B. The effect of M-TAPA block on postoperative analgesia in laparoscopic cholecystectomy. J Anesth. 2021;35(4):589-96.
9. Suzuka T, Tanaka N, Kadoya Y, Ida M, Iwata M, Ozu N, et al. Comparison of quality of recovery between modified thoracoabdominal nerves block through perichondrial approach versus oblique subcostal transversus abdominis plane block in patients undergoing total laparoscopic hysterectomy: a pilot randomized controlled trial. J Clin Med. 2024;13(3):712.doi:10.3390/jcm13030712.
10. Dam M, Moriggl B, Hansen CK, et al. The pathway of injectate spread with quadratus lumborum block. Acta Anaesthesiol Scand. 2017;61(9):1120-9.
11. Elsharkawy H, El-Boghdadly K, Barrington M. Quadratus lumborum block: anatomical concepts and evidence review. Reg Anesth Pain Med. 2019;44(4):548-52.

How to Cite this Article: Bhat S. Modified Thoracoabdominal Plane Block (M-TAPA): Narrative Technical Review. International Journal of Regional Anaesthesia. July-December 2025; 6(2): 00-00. DOI: https://doi.org/10.13107/ijra.2025.v06.i02.00

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The Ever-Evolving Landscape of Online Entertainment: More Than Just Games

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The Ever-Evolving Landscape of Online Entertainment: More Than Just Games

The digital age has fundamentally reshaped how we interact with entertainment. What once involved physical spaces, scheduled showtimes, and tangible media has blossomed into a dynamic, accessible, and incredibly diverse ecosystem. Online entertainment is no longer a niche pursuit; it’s a mainstream phenomenon that caters to a vast array of interests, from the thrill-seeker to the intellectually curious, the social butterfly to the solitary explorer. This evolution isn’t just about new platforms; it’s about a complete redefinition of what entertainment can be, offering unprecedented levels of engagement and personalization.

The sheer breadth of options available today is staggering. We’ve moved far beyond the early days of the internet, where streaming was a novelty and interactive experiences were limited. Now, we have high-definition movies and series on demand, global music libraries at our fingertips, and immersive gaming worlds that blur the lines between reality and fantasy. But the scope extends far beyond these well-known categories. Think about the rise of educational content creators on platforms like YouTube, offering everything from astrophysics lectures to artisanal bread-making tutorials. Consider the explosion of podcasts, covering every conceivable topic, from true crime to historical deep dives, providing a rich audio experience for commuters, exercisers, or anyone seeking to expand their knowledge.

This accessibility is a key driver of the online entertainment revolution. No longer are we limited by geographical location or the constraints of traditional broadcast schedules. A passion for obscure foreign films, a desire to learn a new skill, or the craving for a late-night gaming session can all be satisfied with a few clicks. This democratization of access has empowered creators and consumers alike, fostering a vibrant community where diverse voices can be heard and niche interests can find their audience.

The Rise of Interactive and Social Experiences

One of the most significant shifts in online entertainment has been the move from passive consumption to active participation. Gaming, of course, has always been interactive, but the advent of massively multiplayer online role-playing games (MMORPGs) and esports has taken this to an entirely new level. These platforms foster vibrant online communities where players collaborate, compete, and forge lasting friendships. The social aspect of gaming is undeniable, creating shared experiences that transcend physical boundaries.

Beyond gaming, social media platforms themselves have become a form of entertainment, albeit a unique one. Users engage with content, create their own, and interact with others in real-time. Live streaming services allow for immediate connection with audiences, whether it’s a musician performing live, a chef demonstrating a recipe, or a gamer broadcasting their playthrough. This immediacy and interactivity create a sense of shared presence and community that is deeply engaging.

Even traditional forms of entertainment are adapting. Many streaming services now offer interactive elements within their content, allowing viewers to make choices that affect the narrative. This blurring of lines between viewer and participant is a fascinating development, suggesting a future where entertainment is less about watching and more about doing. The desire for connection and shared experiences is a fundamental human need, and online platforms are providing innovative ways to fulfill it.

Navigating the Digital Playground: Finding Your Niche

With such a vast ocean of content, finding what truly resonates can sometimes feel overwhelming. This is where the beauty of personalization and discoverability algorithms comes into play. Platforms learn our preferences and suggest content tailored to our tastes, helping us uncover hidden gems and explore new avenues of entertainment. However, it’s also important to cultivate a sense of active exploration. Don’t be afraid to step outside your usual comfort zone and try something new.

The world of online entertainment is constantly evolving, with new genres, platforms, and experiences emerging regularly. For those seeking a particular kind of thrill and engagement, the digital landscape offers a multitude of avenues. Whether you’re looking for the excitement of competitive gaming or the simple pleasure of discovering new content, the accessibility of online platforms makes it easier than ever to find what you’re looking for. For example, if you’re interested in exploring various forms of online entertainment, including those that offer dynamic and engaging experiences, finding a reliable portal for such activities is key. A good starting point for exploring these options and ensuring a smooth entry into various digital entertainment spaces is through a trusted source for **casibom giriş**.

The Future of Entertainment: Immersive, Personalized, and Social

Looking ahead, the trajectory of online entertainment points towards even greater immersion and personalization. Virtual reality (VR) and augmented reality (AR) are poised to revolutionize how we experience games, movies, and even social interactions. Imagine stepping directly into the world of your favorite film or attending a virtual concert where you can interact with other attendees.

The role of artificial intelligence (AI) will also become increasingly significant. AI can be used to generate personalized content, create more realistic virtual environments, and even act as interactive characters within entertainment experiences. This will lead to a future where entertainment is not only tailored to our individual preferences but also dynamically adapts to our engagement.

Furthermore, the lines between different forms of entertainment will continue to blur. We may see more hybrid experiences that combine elements of gaming, storytelling, social interaction, and even educational content. The creator economy will continue to flourish, empowering individuals to build audiences and monetize their unique talents and perspectives.

The digital age has gifted us an unparalleled universe of entertainment. It’s a space that encourages exploration, fosters connection, and continuously pushes the boundaries of what’s possible. From the simple joy of watching a favorite show to the complex thrill of competing in a virtual arena, online entertainment offers something for everyone, and its evolution shows no signs of slowing down. The key is to embrace the possibilities, explore with an open mind, and find the experiences that bring you the most joy and engagement.

Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM)

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Vol 5 | Issue 2 | July-December 2024 | Page 10-12| Pratik Bhange, Shruti Patil, Deepali Thakur

DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted: February 02-07-2024; Reviewed: 01-08-2024; Accepted: 22-07-2024; Published: 10-12-2024

Authors: Pratik Bhange [1], Shruti Patil [1], Deepali Thakur [1]

[1] Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Pratik Bhange,
Department of Anaesthesiology, LTMMC & GH, Mumbai, Maharashtra, India
E-mail: pratikbhange96@gmail.com

Abstract

The presentation of hypertrophic obstructive cardiomyopathy may vary from an asymptomatic patient to sudden death. The changes in preload, afterload and ventricular contractility may occur due to surgery, anaesthesia and fluid shifts in the perioperative period. This causes worsening of the left ventricular outflow tract obstruction, ultimately causing myocardial ischemia and cardiac dysrhythmias. This case discusses successful anaesthesia management of a 49-year-old male with hypertrophic obstructive cardiomyopathy operated for tibia and fibula open reduction, internal fixation using ultrasound-guided sciatic and femoral nerve block. Transthoracic Echocardiography served as an additional monitoring modality to assess cardiac function intraoperatively. The patient underwent successful surgery with stable hemodynamics and reported excellent pain relief postoperatively.
Keywords: Hypertrophic obstructive cardiomyopathy, Transthoracic Echocardiography, Peripheral nerve block

References

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How to Cite this Article: Bhange P, Patil S, Thakur D | Ultrasound Guided Peripheral Nerve Block For Lower Limb Fracture Fixation In A Patient With Hypertrophied Obstructive Cardiomyopathy (HOCM) | International Journal of Regional Anaesthesia | July-December 2024; 5(2): 13-15 | DOI: https://doi.org/10.13107/ijra.2024.v05.i02.96

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Genomics and Precision Analgesia: Is this the era?

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Vol 6 | Issue 1 | January-June 2025 | Page 15-19 | Bhuvaneswari Balasubramanian, Sandeep Diwan

DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 24-02-2025; Reviewed: 19-03-2025; Accepted: 19-05-2025; Published: 10-06-2025

Authors: Bhuvaneswari Balasubramanian [1]

 Sandeep Diwan [2]

[1] Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
[2] Department of Anaesthesiology, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence

Dr. Bhuvaneswari Balasubramanian
Department of Anaesthesiology & Critical Care, AIIMS, Nagpur, Maharashtra, India.
Email: docbhuvaneswari@gmail.com

Abstract

Interindividual variability in analgesic response reflects heritable differences in drug metabolism, receptor expression, neurotransmitter turnover, and central nervous system drug transport. Pharmacogenomic advances have clarified functional consequences of polymorphisms in CYP2D6, CYP3A4, UGT2B7, OPRM1, COMT, and ABCB1, each of which influences opioid and non-opioid pharmacokinetics and pharmacodynamics. CYP2D6 metabolizer status determines conversion of prodrugs such as codeine and tramadol to active metabolites, while CYP3A4 variation modulates systemic opioid clearance. OPRM1 A118G alters μ-opioid receptor binding affinity and signaling, COMT Val158Met influences catecholamine-mediated pain sensitivity, and ABCB1 variants affect opioid penetration across the blood–brain barrier. Clinical studies demonstrate genotype-associated differences in analgesic efficacy and toxicity, though effect sizes vary across populations and analgesic classes. Implementation remains constrained by limited genotype-stratified randomized trials, testing turnaround time, unclear cost-effectiveness, and underrepresentation of Asian and Southeast Asian ancestry groups in genomic datasets. This mini-review synthesizes mechanistic foundations, clinical evidence, population variation, and practical considerations for integrating pharmacogenomics into perioperative and chronic pain management.
Keywords: Genomics, Pharmacogenetics, Precision medicine, Analgesia, CYP2D6, Postoperative pain, Opioids

References

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How to Cite this Article: Balasubramanian B, Diwan S. Genomics and Precision Analgesia – Is This the Era? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 15-19. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.116

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Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It?

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Vol 6 | Issue 1 | January-June 2025 | Page 08-14 | Divesh Arora

DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted: 28-02-2025; Reviewed: 22-03-2025; Accepted: 25-05-2025; Published: 10-06-2025

Authors: Divesh Arora [1]

[1] Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.

Address of Correspondence

Dr. Divesh Arora,
Director & HOD, Department of Anaesthesia & OT Services, Asian Hospital, Faridabad, Haryana, India.
Email ID: drdivesh@gmail.com

Abstract

Intrafascicular injection represents one of the most serious complications in regional anaesthesia, potentially resulting in irreversible neurological injury. Despite the advances in ultrasound-guided techniques, inadvertent intraneural and intrafascicular injections still occur. This review synthesizes the current understanding of nerve microanatomy, mechanisms of nerve injury, and the diagnostic and preventive strategies aimed at avoiding this catastrophic event. It highlights the role of ultrasound technology, echogenic needle innovations, injection pressure monitoring, neurostimulation, and emerging applications of artificial intelligence in enhancing procedural safety. The integration of these multimodal safety tools can significantly reduce operator dependency and improve real-time feedback during nerve block procedures. With continued technological refinement, structured training, and incorporation of AI-assisted imaging and robotics, the risk of intrafascicular injection can be minimized, thereby improving patient safety and outcomes in regional anaesthesia.
Keywords: Intrafascicular injection, Regional anaesthesia safety, Ultrasound guidance, Echogenic needles, Pressure monitoring, Artificial intelligence.

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How to Cite this Article: Arora D. Intrafascicular Injection: Can AI, Ultrasound, Pressure Monitoring, and Echogenic Needles Prevent It? International Journal of Regional Anaesthesia. January-June 2025; 6(1): 08-14. DOI: https://doi.org/10.13107/ijra.2025.v06.i01.114

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