Abdominal Wall Blocks in Abdominal Surgery: An Update

Vol 2 | Issue 1 | January-June 2021 | Page 47-53 | TVS Gopal, Amjad Maniar, Arunangshu Chakraborty,
Rammurthy Kulkarni

Authors:  TVS Gopal [1], Amjad Maniar [2], Arunangshu Chakraborty [3], Rammurthy Kulkarni [2]

[1] Department of Anaesthesia, Care Hospitals, Banjara Hills, Hyderabad, Andhra Pradesh, India.
[2] Department of Anaesthesia, Axon Anaesthesia Associates, Bengaluru, India.
[3] Department of Anaesthesia, Tata Medical Center, Kolkata, India.

Address of Correspondence
Dr. TVS Gopal,
Clinical Director, Care Hospitals, Banjara Hills, Hyderabad, Andhra Pradesh, India.


Abdominal wall blocks provide an alternative to the gold standard, epidural analgesia, as a part of a multimodal analgesic regime for pain relief following a variety of abdominal surgeries. The ubiquitous availability of ultrasound and the paradigm shift to deposition of local anaesthetic into interfascial planes popularized abdominal wall blocks. Over the years, a better understanding of cadaveric, clinical sonoanatomy, and techniques have emerged. However, with certain abdominal wall blocks, the spread of local anaesthetic is neither consistent nor predictable. This concise update presents details pertaining to ultrasound-guided abdominal wall blocks.


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How to Cite this Article: Gopal TVS, Maniar A, Chakraborty A, Kulkarni R | Abdominal Wall
Blocks in Abdominal Surgery: An Update | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 47-53.

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Sterility Protocols During Regional Anaesthesia: An AORA Initiative

Vol 2 | Issue 1 | January-June 2021 | Page 05-12 | Rammurthy Kulkarni, Amjad Maniar, Neha Singh, Vrushali Ponde, Kapil Gupta, Mohammad Azam Danish, Ritesh Roy, Archana Areti

Authors: Rammurthy Kulkarni [1], Amjad Maniar [1], Neha Singh [6], Vrushali Ponde [4], Kapil Gupta [3], Mohammad Azam Danish [5], Ritesh Roy [2], Archana Areti [7]

[1] Department of Anaesthesia, Axon Anaesthesia Associates, Bengaluru, Karnataka, India.
[2] Department of Anaesthesia, AIIMS, Bhubhaneshwar, Odisha, India.
[3] Director Child Anaesthesia Services, Mumbai, Maharashtra, India.
[4] Department of Anaesthesia, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi, India.
[5] Department of Anaesthesia, B. M. Jain Hospital, Bengaluru, Karnataka, India.
[6] Associate Clinical Director and HOD, Care Hospitals, Bhubaneshwar, Odisha, India.
[7] Department of Anaesthesia, Mahatma Gandhi Medical College Research Institute Puducherry, India.

Address of Correspondence
Dr. Vrushali Ponde, Director Child Anaesthesia Services, Mumbai, Maharashtra, India.


The frequency of infection following peripheral nerve block (PNB) is not very clear. The major reason for the paucity of literature is under-reporting of infectious complications. Though rare, the infectious complications associated with peripheral nerve blocks can be devastating and occasionally fatal.1 One case of necrotising fasciitis following an axillary approach to brachial plexus blockade for carpal tunnel release has been reported where the PNB was directly attributed to the infection. With the increase in the number of peripheral nerve block procedures being performed (both single injection and continuous techniques), it is expected that the infectious complication rate may also increase.
There is no uniform consensus amongst anaesthesiologists across the globe regarding the appropriate sterile technique that should be practised during the administration of regional anaesthesia. In a UK and Ireland based survey of obstetric anaesthesiologists, only half of the responders wore a face mask for both neuraxial (spinal and epidural) techniques. One-third of those who did not wear a mask believed that the mask actually increased the risk of infection.2 It can be easily assumed that a similar attitude is present while performing PNBs.
The aseptic chain starts right from hand washing and ends after the block needle has been taken out from the patient’s body (in a single injection technique) or till the perineural catheter is completely removed (in a continuous technique). Any breach in this chain may increase the chances of introducing infection.


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How to Cite this Article: Kulkarni R, Maniar A, Singh N, Ponde V, Gupta K, Danish MA, Roy R, Areti A | Sterility Protocols During Regional Anaesthesia: An AORA Initiative | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 05-12.

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Anatomy of Brachial Plexus Above The Clavicle

Vol 2 | Issue 1 | January-June 2021 | Page 29-34 | Shivaprakash S, Georg Feigl, Sandeep M. Diwan

Authors: Shivaprakash S [1], Georg Feigl [2], Sandeep M. Diwan [3]

[1] Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
[2] Private Universitat Witten/Herdecke gGmbH Alfred-Herrhausen-StraBe 50, D-58448 Witten.
[3] Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Sandeep Diwan,
Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.


The neck is a compact structure which hosts the aero-digestive and neurovascular structures. Nerve roots arising from the spinal cord form an important network of nerves the ‘Brachial Plexus (BP)’ that innervates the upper limb and lies partly in the posterior triangle of neck and partly in the axilla. The BP is complex matrix sandwiched between muscles proximally and muscles and vessels distally at and above the level of clavicle. It consists of roots, trunks, cords & branches (figure 1). Roots and trunks are supraclavicular, divisions are retro clavicular, cords and their branches are infraclavicular. The position of the plexus relative to the clavicle varies, it is higher in the erect position and lower when recumbent [1]. It is broad and presents little of a plexiform arrangement at its commencement, is narrow opposite the clavicle, divides opposite the coracoid process into numerous branches and becomes broad and forms a denser interlacement in the axilla [2]. Brachial plexus is formed by the ventral rami of lower four cervical nerves and the first thoracic spinal nerves with variable contribution (slender twigs) from the fourth cervical and second thoracic nerve.


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How to Cite this Article: Shivaprakash S, Feigl G, Diwan SM | Anatomy of Brachial Plexus Above The Clavicle | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 29-34.

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Cadaveric Workshop and Implications in Regional Anaesthesia

Vol 2 | Issue 1 | January-June 2021 | Page 22-28 | Ramkumar Mirle, Sajana Mukundan

Authors: Ramkumar Mirle [1], Sajana Mukundan [1]

[1] Department of Anaesthesia, Columbia Asia Referral Hospital, Yeshwanthpur, Bangalore, Karnataka, India.

Address of Correspondence
Dr. Ram Kumar M. M,
Consultant Anaesthesiologist, Columbia Asia Referral Hospital, Yeshwanthpur, Bangalore, Karnataka, India.


The human cadavers have always been an immense source of knowledge from time immemorial and have been aptly termed as “Silent teachers” [1]. Cadaver dissection has been the basis of teaching anatomy to aspiring anaesthesiologist to develop their skills in regional anaesthesia. The practice of regional anaesthesia has evolved from the landmark based technique eliciting paraesthesia to peripheral nerve stimulation-guided technique and in the recent times to use of ultrasound guided (USG) technique alone or a combination of (PNS) and USG – Dual Modality. Successful regional nerve block technique can be a combination of any of these techniques with the most reliable modality depending on the expertise of the performer. In order to excel we need to be appropriately trained akin to a real-life scenario. The cadaver workshop has not only facilitated understanding anatomy but also helped in acquiring practical clinical skills.


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How to Cite this Article: Mirle R, Mukundan S | Cadaveric Workshop and Implications in Regional Anaesthesia | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 22-28.

Acknowledgment: M S Ramaiah Advanced Learning Centre, Bangalore, Karnataka, India.

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