Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia
Vol 5 | Issue 1 | January-June 2024 | Page 24-29| S. Narmatha Yangste, S. Shankar Raju, Bhaskar
DOI: https://doi.org/10.13107/ijra.2024.v05.i01.087
Authors: S. Narmatha Yangste [1], S. Shankar Raju [2], Bhaskar [3]
[1] Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
[2] Department of Anesthesiology, ESI medical college, Coimbatore, Tamil Nadu, India.
[3] Department of Anesthesiology, Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India.
Address of Correspondence
Dr. S. Narmatha Yangste,
Associate Professor, Department of Anesthesiology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
E-mail: nyangtse75@gmail.com
Abstract
Background and Aim: Ultrasound-guided inferior vena cava collapsibility index (IVCCI) is used for assessing the volume status of the patient in critical care but for emergency cases taken up under spinal anesthesia this index helps to assess the adequacy of resuscitation. In our study, we aimed to evaluate the usefulness of ultrasound in adequately resuscitating patients requiring subarachnoid block for emergency lower limb orthopedic surgeries.
Methods: After obtaining approval from the Coimbatore Medical College institutional ethical committee, 60 adults aged between 20 and 60 comprising both sexes requiring emergency lower limb [shaft of femur] orthopedics surgeries were included in this randomized clinical study. After a complete pre-anaesthetic assessment, IVCCI by ultrasound is measured. The patient was resuscitated to a target IVCCI of ≤30% before performing the subarachnoid block from the USG group. The other group of patients was resuscitated till the mean arterial pressure (MAP) was≥65 mm Hg from the MAP group. Then spinal anaesthesia was performed in a sitting position via L3 – L4 interspace using a 25 G Quincke’s needle. The parameters were monitored every 5 minutes for 30 minutes post-spinal.
Results: The incidence and severity of hypotension are lesser in the ultrasound group compared to the MAP group which was statistically significant (p=0.004).
Conclusion: Our study concludes that the USG-guided fluid resuscitation with a target IVCCI ≤30% for emergency surgeries under spinal anaesthesia does reduce the severity of hypotension and its adverse outcomes.
Keywords: Inferior vena cava, Lower limb, Fracture, Mean arterial pressure, Ultrasound, Spinal anesthesia
References
1) B Ayyanogouda, BC Ajay, Chhaya joshi et al., Role of ultrasonographic inferior venacaval assessment in averting spinal anaesthesia-induced hypotension for hernia and hydrocele surgeries-A prospective randomised controlled study, Indian J Anaesth2020 Oct;64(10): 849-854. 1.
2) Ceruti S, Anselmi L, Minotti B, Franceschini D, Aguirre J, Borgeat A, Saporito A. Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management. Br J Anaesth. 2018 Jan;120(1):101-108. doi: 10.1016/j.bja.2017.08.001. Epub 2017 Nov 23. PMID: 29397116.
3) M J Kaptein,Elaine M Kaptein, Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume,Adv Chronic Kidney Dis. 2021 May 28(3): 218-226..
4) Zhang J, Critchley LA. Inferior vena cava ultrasonography before general anesthesia can predict hypotension after induction. Anesthesiology. 2016 Mar 1;124(3):580-9.
5) E R Salama, Mohamed Elkashlan, Pre-operative ultrasonographic evaluation of inferior vena cava collapsibility index and caval aorta index as new predictors for hypotension after induction of spinal anaesthesia: A prospective observational study, Eur J anesthesiol 2019 Apr;36(4):297-302.
6) M Szabo,Anna Bozo, Katalin Darvas et tal,. Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: an observational study BMC anaesthesiology 2019 Aug 7;19(1):139.
7) T Saranteas,H spiliotaki,L koloantzaki et tal ,The Utility of Echocardiography for the Prediction of Spinal-Induced Hypotension in Elderly Patients: Inferior Vena Cava Assessment Is a Key Player, J cardiothoracic Vasc Anesth 2019 Sep; 33(9): 2421-2127.
8) Shyam Sundar Purushothaman , Ani Alex , Rajesh Kesavan , Sindhu Balakrishnan Sunil Rajan , Lakshmi Kumar , Ultrasound Measurement of Inferior Vena Cava Collapsibility as a Tool to Predict Propofol-Induced Hypotension, Anesth Essays Res. Apr-Jun 2020;14(2):199-202.
9) Arthur K Au , Dean Steinberg , Christopher Thom , Maziar Shirazi , Dimitrios Papanagnou et tal, Ultrasound measurement of inferior vena cava collapse predicts propofol-induced hypotension, Am J Emerg Med. 2016 Jun;34 (6):1125-8.
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11) Huang B, Huang Q, Hai C, Zheng Z, Li Y, Zhang Z. Height-based dosing algorithm of bupivacaine in spinal anaesthesia for decreasing maternal hypotension in caesarean section without prophylactic fluid preloading and vasopressors: study protocol for a randomised controlled non-inferiority trial. BMJ Open. 2019 May 16;9(5):e024912.
12) Hartmann B et al. The incidence and risk factors for hypotension after spinal anesthesia induction: An analysis with automated data collection. Anesth Analg 2002;94:1521-9.
13) Carpenter RL et al,. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992;76:906-16
14) Singh J et al,. Effect of preloading on hemodynamic of the patient undergoing surgery under spinal anaesthesia. Kathmandu Univ Med J 2010;8:216-21.
15) Khan MU et al,. Preload versus coload and vasopressor requirement for the prevention of spinal anesthesia induced hypotension in nonobstetric patients. J Coll Physicians Surg Pak 2015;25:851-5.
16) S Mohammed et al,. Indian J Anaesth., 2021 Oct;65(10): 731-737. Prediction of post induction hypotension in young adults using ultrasound derived inferior venacava parameters: An observational study.
| How to Cite this Article: Raju SS, Yangste SN, Kalyanasundaram K | Effectiveness of Using Ultrasound-Inferior Venacava Collapsibility Index (IVCCI) as a Guidance Tool for Resuscitating the Patients Undergoing Emergency Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 24-29 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.87 |
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Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region
Vol 5 | Issue 1 | January-June 2024 | Page 30-31| Pooja Jadhao, Sandeep Diwan
DOI: https://doi.org/10.13107/ijra.2024.v05.i01.088
Authors: Pooja Jadhao [1], Sandeep Diwan [1]
[1] Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.
Address of Correspondence
Dr. Pooja Jadhao,
Department of Anaesthesiology, Sancheti Hospital and Rehabilitation Centre, Pune, Maharashtra, India.
E-mail: poojajadhao533@gmail.com
Abstract
The brachial plexus at supraclavicular division level is superior and lateral to the subclavian artery. Thus needle tip positions are already published in literature. However we report the brachial plexus divisions on the medial side of the subclavian artery. This might result in inadequate or failed blocks with landmark guided technique. Moreover with ultrasound needle tip needs to advance medial to artery making it more difficult in expert hands too. Ultrasound imaging of brachial plexus helps in identifying anamolous position of brachial plexus divisions.
Keywords- Brachial plexus divisions, Subclavian artery, Ultrasound
References
1. Kessler J, Gray AT. Sonography of scalene muscle anomalies for brachial plexus block. Reg Anesth Pain Med. 2007; 32:172-3.
2. Chin KJ, Niazi A, Chan V. Anomalous brachial plexus anatomy in the supraclavicular region detected by ultrasound. Anesth Analg.2008;107:729-31
3. Padur AA, Kumar N, Shanthakumar SR, Shetty SD, Prabhu GS, Patil J. Unusual and unique variant branches of lateral cord of brachial plexus and its clinical implications ‒ A cadaveric study. J Clin Diagn Res. 2016;10:AC01-4.
4. Royse CF, Sha S, Soeding PF, Royse AG. Anatomical study of the brachial plexus using surface ultrasound. Anaesth Intensive Care 2006; 34:203–10.
5. Ramanujam V, Kirk PV. Anatomy variation of brachial plexus trunks during supraclavicular nerve block: clinical image. Braz J Anesthesiol. 2022 Nov-Dec;72(6):834-835.
6. Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg 2003;97: 1514–7.
| How to Cite this Article: Jadhao P, Diwan S | Anomalous Brachial Plexus and their Relationship to the Subclavian Artery in the Supraclavicular Region | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 30-31 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.88 |
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The Ever-Evolving Landscape of Modern Communication
The Ever-Evolving Landscape of Modern Communication
In today’s interconnected world, communication has transcended geographical boundaries and evolved at an unprecedented pace. From the simple act of exchanging letters to the complex realm of digital interactions, the ways in which we connect with one another are constantly being reshaped by technological advancements and societal shifts. Understanding this ever-evolving landscape is crucial for navigating personal relationships, professional endeavors, and the broader global community.
The Rise of Digital Communication
The advent of the internet revolutionized communication, ushering in an era of instant messaging, email, and video conferencing. These tools have not only streamlined business operations but have also transformed personal relationships, allowing individuals to stay connected with loved ones across vast distances. Social media platforms have further amplified this trend, providing avenues for individuals to share their thoughts, experiences, and perspectives with a global audience.
However, the rise of digital communication has also presented challenges. The anonymity afforded by the internet has contributed to the spread of misinformation and online harassment. The sheer volume of information available online can be overwhelming, making it difficult to discern credible sources from unreliable ones. Furthermore, the constant connectivity demanded by digital communication can lead to burnout and a sense of being perpetually “on.”
Social Media’s Impact on Society
Social media has become an undeniable force in modern society, influencing everything from political discourse to consumer behavior. Platforms like Facebook, Twitter, and instagram have provided individuals with unprecedented opportunities to connect with like-minded people, organize social movements, and promote their businesses or personal brands. News and information now spread virally, often bypassing traditional media outlets. This immediacy can be both beneficial and detrimental, allowing for rapid responses to crises but also contributing to the spread of unverified or misleading content.
The curated nature of social media profiles can also contribute to unrealistic expectations and social comparison. The constant exposure to carefully crafted images and narratives can lead to feelings of inadequacy and anxiety, particularly among young people. It’s important to remember that social media often presents a highly filtered version of reality and to cultivate a healthy perspective on the information we consume online.
The Art of Effective Communication in a Digital Age
In a world saturated with information, the ability to communicate effectively is more important than ever. Whether you’re crafting an email, giving a presentation, or engaging in a social media conversation, clear, concise, and compelling communication can make all the difference. Here are some tips for honing your communication skills in the digital age:
- Know your audience: Tailor your message to the specific interests and needs of your audience.
- Be clear and concise: Get to the point quickly and avoid unnecessary jargon.
- Use visuals: Incorporate images, videos, and infographics to enhance your message.
- Be engaging: Ask questions, tell stories, and encourage interaction.
- Be respectful: Engage in respectful dialogue, even when you disagree with someone’s perspective.
- Proofread your work: Errors in grammar and spelling can undermine your credibility.
Looking Ahead: The Future of Communication
The future of communication is likely to be shaped by emerging technologies such as artificial intelligence (AI), virtual reality (VR), and augmented reality (AR). AI-powered chatbots are already being used to provide customer service and personalized recommendations. VR and AR technologies have the potential to create immersive and interactive communication experiences. Imagine attending a virtual meeting where you can interact with colleagues as if you were in the same room, or using AR to overlay digital information onto the real world.
As these technologies continue to evolve, it’s important to consider their potential impact on society. Will they further enhance our ability to connect and collaborate, or will they exacerbate existing inequalities and contribute to social isolation? The answer will depend on how we choose to develop and deploy these technologies. By prioritizing ethical considerations and focusing on human-centered design, we can ensure that the future of communication is one that fosters understanding, empathy, and connection.
In conclusion, the landscape of modern communication is constantly changing, presenting both opportunities and challenges. By embracing new technologies, honing our communication skills, and remaining mindful of the potential impacts of these changes, we can navigate this evolving landscape and build a more connected and informed world.
The Fate of Lumbar Epidural Catheters in the Postoperative Period- A Retrospective Single-center Audit
Vol 4 | Issue 2 | July-December 2023 | Page 14-17 | Sandeep Diwan, Himaunshu Dongre, Parag Sancheti
DOI: https://doi.org/10.13107/ijra.2023.v04i02.077
Submitted: 26-06-2023; Reviewed: 18-07-2023; Accepted: 23-10-2023; Published: 10-12-2023
Authors: Sandeep Diwan [1], Himaunshu Dongre [1], Parag Sancheti [2]
[1] Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra, India.
[2] Department of Orthopaedics, Sancheti Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Himaunshu Dongre,
Department of Anesthesiology, Sancheti Hospital, Pune, Maharashtra State, India.
E-mail: himaunshu.dongre@gmail.com
Abstract
This paper describes a retrospective audit of fate of epidural catheters in post operative period in adults and elderly patients (more than 65 years) receiving epidural infusion analgesia (EIA) in a single institute. Epidural catheters can either migrate inwards (inward migration of epidural catheter or IMEC) otherwise, outwards (outward migration of epidural catheter or OMEC). The OMEC can lead to failure of epidural analgesia and loss of infusate. The primary aim was to evaluate the incidence of OMEC. The secondary aim was, disconnections, kinking, knotting and breakage of catheter. The primary and secondary aim together were considered as fate of epidural catheter. Our study demonstrates the OMEC occurred at 1.12%, disconnection at 7.32%, kink and knot at 1.12% and 0.016% respectively A good communication at all levels (anesthesiologist-handlers at each level-nursing staff), in event of raised incidence (inform the QHC and concerned anesthesiologist) is mandatory to avoid mishandling of epidural assembly. After identifying some of the causes including the dressing material and fixation methods, changes were implemented which will be audited in the subsequent study.
Keywords: Epidural catheter migration, Audit, Observational Study
References
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10. Tripathi M, Pandey M. Epidural catheter fixation: subcutaneous tunnelling with a loop to prevent displacement. Anaesthesia. 2000; 55:1113-6.
11. Clark MX, O’Hare K, Gorringe J, Oh T. The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trial. Anaesthesia. 2001; 56: 865-70.
| How to Cite this Article: Diwan S, Dongre H, Sancheti P | The Fate of Lumbar Epidural Catheters in the Postoperative Period- A Retrospective Single-center Audit | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 14-17 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.077 |
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Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly
Vol 4 | Issue 2 | July-December 2023 | Page 9-13 | Tamasi Dawn, Yatindra Kumar Batra, Sunny Rupal, Komal Jit Kaur, Tanvir Samra
DOI: https://doi.org/10.13107/ijra.2023.v04i02.076
Submitted: 10-08-2023; Reviewed: 06-09-2023; Accepted: 24-10-2023; Published: 10-12-2023
Authors: Tamasi Dawn [1], Yatindra Kumar Batra [1], Sunny Rupal [1], Komal Jit Kaur [1], Tanvir Samra [2]
[1] Department of Anaethesiology Max superspeciality Hospital, Mohali, Punjab, India.
[2] Department of Anaesthesia PGIMER, Chandigarh, India.
Address of Correspondence
Dr. Tanvir Samra,
Associate Professor Department of Anaesthesia PGIMER, Chandigarh, India.
E-mail: drtanvirsamra@yahoo.co.in
Abstract
Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space.
Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups.
Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable.
Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries.
Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged
References
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12. Chohedri A, RaeesiEstabragh R, Eghbal MH, Sahmeddini MA, Eftekharian H, Shahabifar R. Comparing the Duration of Spinal Anesthesia Induced With Bupivacaine and a Bupivacaince- Lidocaine Combination in Trans-Urethral Resection of the Prostate (TURP). Anesth Pain Med 2015;5: e25675.
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| How to Cite this Article: Dawn T, Batra YK, Rupal S, Kaur KJ, Samra T | Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly | International Journal of Regional Anaesthesia | July- December 2023; 4(2): 9-13 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.076 |
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Thoracic Wall Blocks for Thoracic Surgery
Vol 4 | Issue 2 | July-December 2023 | Page 01-08 | Neha Pangasa, Anjolie Chhabra
DOI: https://doi.org/10.13107/ijra.2023.v04i02.075
Submitted: 08-07-2023; Reviewed: 01-09-2023; Accepted: 09-10-2023; Published: 10-12-2023
Authors: Neha Pangasa [1], Anjolie Chhabra [1]
[1] Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Address of Correspondence
Dr. Neha Pangasa
Assistant Professor, Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Email- nehapangasa@gmail.com
Abstract
Thoracic epidural, paravertebral block and intercostal nerve block were the conventional methods of providing analgesia for thoracic surgery, about a decade ago. In the modern era with the advent of ultrasound guided regional anesthesia, the fascial plane blocks came as a boon to anesthesiologists. These blocks are safer, as the needle tip remains distant from the pleura and they are technically easier to perform. We have described in brief the various techniques for thoracic wall analgesia with special emphasis to fascial plane blocks, along with the current evidence for each block.
Keywords: Thoracic wall blocks, Fascial plane blocks, Local anaesthetic
References
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2. Nair S, Gallagher H, Conlon N. Paravertebral blocks and novel alternatives. BJA Education 2020, 20(5): 158-65.
3. Karmakar MK. Thoracic Paravertebral Block. Anesthesiology 2001; 95:771– 80.
4. Yeung JHY, Gates S, Naidu BV, Leuwer M, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database of Systematic Reviews 2011; 5. Art. No.: CD009121.
5. Lönnqvist PA, MacKenzie J, Soni AK, Conacher ID. Paravertebral blockade: failure rate and complications. Anaesthesia. 1995 Sep;50(9):813-5.
6. Chhabra A, Chowdhury AR, Prabhakar H, Subramaniam R, Arora MK, Srivastava A, Kalaivani M. Paravertebral anaesthesia with or without sedation versus general anaesthesia for women undergoing breast cancer surgery. Cochrane Database of Systematic Reviews. 2021(2).
7. Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state of the art review. Anaesthesia 2021, 76: 110–26.
8. Elsharkawy H, Pawa A, Mariano ER. Interfascial plane blocks: back to basics. Reg Anesth Pain Med 2018; 43: 341–6.
9. Blanco R. The ‘pecs block’: a novel technique for providing analgesia after breast surgery. Anaesthesia 2011; 66: 847–8.
10. Blanco R, Fajardo M, Parras MT. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Revista Espanola De Anestesiologia Y Reanimacion 2012; 59: 470–5.
11. Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68: 1107–13.
12. Johnston DF, Black ND, O’Halloran R, Turbitt LR, Taylor SJ. Cadaveric findings of the effect of rib fractures on spread of serratus plane injections. Canadian Journal of Anesthesia 2019; 66: 738–9.
13. Chin KJ ,Kariem ,Boghdadly KE. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anesth 2021; 68:387–408.
14. Moustafa MA, Alabd AS, Ahmed AM, Deghidy EA. Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth 2020;64:49-54.
15. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Regional Anesthesia & Pain Medicine. 2016 Sep 1;41(5):621-7.
16. Yang H.M ,Choi Y.J, Kwon HJ, J. O, Cho T.H, Kim S.H. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia 2018, 73, 1244–50.
17. Ivanusic J, Konishi Y, Barrington M.J. A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade. Reg Anesth Pain Med 2018;43: 567–71.
18. Huang W, Wang W , Xie W , Chen Z , Liu Y. Erector spinae plane block for postoperative analgesia in breast and thoracic surgery: A systematic review and meta-analysis. J. Clin Anesth 2020; 66: 109900.
19. Adhikary SD, Liu WM, Fuller E, Cruz-Eng H, Chin KJ. The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia 2019; 74: 585–93.
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21. Murouchi T, Yamakage M. Retrolaminar block: analgesic efficacy and safety evaluation. J Anesth 2016;30(6):1003-07.
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| How to Cite this Article: Pangasa N, Chhabra A | Thoracic Wall Blocks for Thoracic Surgery | International Journal of Regional Anaesthesia | July-December 2023; 4(2): 01-08 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.075 |
