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Purpose: Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. Methods: The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. Results: There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33–3.509)] and movement [2.40 (1.20–4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100–300); Group 2: 37.5 (0–200); p < 0.001]. Conclusion: Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907). [ABSTRACT FROM AUTHOR]

Erector spinae plane (ESP) block spread can be unpredictable. We previously improved the spread of ESP injection by addition of retrolaminar (RL) injection. However, it is not clear whether spread at high thoracic levels is similar to spread at midthoracic levels. Our primary objective was to demonstrate that craniocaudal dye spread was equivalent after combined ESP and RL injection using a 19 G Tuohy needle at the third (T3) and sixth (T6) vertebrae in soft embalmed Thiel cadavers. We randomised 20 combined ESP and RL injections to the T3 and T6 vertebral levels on both sides of 10 prone Thiel cadavers. A 3–8 MHz transducer was placed in the paramedian sagittal plane and a single anaesthetist injected 10 ml dye onto the transverse process, then 10 ml dye onto the laminae of T3 or T6. Cadavers were dissected 24 h later. Mean (sd) craniocaudal spread of dye after combined ESP + RL injection at T3 and T6 vertebral levels was equivalent: 8.6 (1.8) vs 8.7 (2.3) levels, respectively; difference (90% confidence interval): –0.1 (–1.4 to 1.6), P =0.904. Dye extended uniformly, cranially and caudally, from the point of injection. A 3D prosection created from a Thiel cadaver confirmed that the dorsal ramus emerges from the costotransverse foramen deep to the intertransverse ligament within the retro-superior costotransverse ligament space. Combined ESP and RL block in six patients before mastectomy achieved extensive anterior, lateral, and posterior chest wall paraesthesia over four to six dermatomes. Combined ESP and RL injections showed equivalent and consistent spread at T3 and T6 injection sites. A pilot study confirmed translation to patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. Methods: The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. Results: The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Conclusion: Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

Background and Aims: Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. Methods: The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. Results: The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Conclusion: Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy. [ABSTRACT FROM AUTHOR]

Xiaoyun Gao,&ast; Moxi Chen,&ast; Penghao Liu, Shenyuan Zhou, Sai Kong, Junfeng Zhang, Jun Cao Department of Anesthesiology, Shanghai Sixth People’s Hospital, Shanghai, 200233, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jun Cao, Department of Anesthesiology, Shanghai Sixth People’s Hospital, No. 600, Yishan Road, Shanghai, 200233, People’s Republic of China, Tel +86 18930173661, Email dr_caojun@sina.comBackground: A novel ultrasound-guided paravertebral block, the edge laminar block (ELB) was reported recently. However, it was unclear how effective ELB was in comparison with traditional blocking methods. We conducted a trial to compare the analgesic efficacy of ELB with the thoracic paravertebral block (TPVB) and the retrolaminar block (RLB) in patients undergoing video-assisted thoracic surgery (VATS).Methods: We identified 90 patients who were scheduled for VATS and randomly assigned them to three groups: ELB group (Group E), TPVB group (Group T), and RLB group (Group R). Each group underwent ELB, TPVB, and RLB, respectively, under ultrasound guidance before general anesthesia induction. All patients received post-operative routine analgesia protocol. Our primary outcome was the extent of dermatomal sensory loss on the midclavicular, midaxillary, and scapular lines, measured using a pinprick 15 minutes after the nerve block. Secondary outcomes included the intraoperative dose of sufentanil, the numerical rating scale (NRS) scores assessed in the post-anesthesia care unit (PACU) and at 6, 12, and 24 hours post-operatively, and pethidine administrated as analgesic rescue dose.Results: The percentages of nerve block range reaching the midclavicular line, midaxillary line, and scapular line in Group E were 96.7%, 93.3%, 93.3%, and 60% in Group T and 30%, 56.7%, and 96.7% in Group R, respectively. Group E had wider dermatomal sensory loss on the midclavicular line and midaxillary line compared to Group R (P

Patients undergoing spine surgeries may experience intense postoperative pain and its related complications such as increased opioid use and delayed early ambulation. Therefore, adequate perioperative pain management is important to promote patient's recovery. In addition, many patients often present with pre-existing chronic pain and opioid use. Although regional analgesic techniques are widely used in other surgical fields, the use of this modality for spine surgery is still evolving. This review article discusses the use of regional analgesic techniques for pain management during spine surgeries. Specifically, we will review fascial plane blocks including erector spinae plane block, retrolaminar block, transversus abdominis plane block, thoracolumbar interfascial plane block, modified thoracolumbar interfascial plane block, multifidus cervicis plane block, and superficial cervical plexus block. In addition, the use of liposomal bupivacaine is discussed. Regional analgesic techniques are described as part of multimodal analgesia regimens and show promising analgesic effects and favorable outcomes in spine surgery. However, the results from the most recent articles revealed only a short-term and limited benefit. Further well-designed studies with greater sample sizes are needed to clarify the effects of regional analgesic techniques on perioperative pain management, including long-term benefits. [ABSTRACT FROM AUTHOR]

Simple Summary: Ultrasound guidance enables direct visualisation of local anaesthetic spread during the performance of regional anaesthetic techniques, thus improving their accuracy and effectiveness while minimising their complications. In human patients receiving thoracic analgesia, a new regional anaesthetic technique, named retrolaminar block, has a lower complication risk when compared with the gold standard, thoracic paravertebral block. The aim of this study was to develop an ultrasound-guided thoracolumbar retrolaminar technique to provide thoracolumbar analgesia in dogs. Another aim was to compare the distribution of contrast solution between the ultrasound-guided and landmark-guided techniques in canine cadavers, using computed tomography. Ten canine cadavers were randomised to receive either an ultrasound-guided or a landmark-guided retrolaminar injection of 0.6 mL/kg of iodinated contrast solution in each hemithorax at the level of the twelfth thoracic vertebra. The injectate spread in a similar manner in the retrolaminar space and the space surrounding the intervertebral foramina, while minimal spread was noted in the paravertebral space. One of the landmark-guided injections failed to spread, thus highlighting the importance of ultrasound guidance in improving outcomes in regional anaesthetic techniques. Further studies are warranted to clarify the role of the ultrasound-guided retrolaminar technique in the management of thoracolumbar pain in dogs. The retrolaminar block was developed in humans as an easier and safer alternative to the thoracic paravertebral block. This study aims to describe an ultrasound-guided thoracolumbar retrolaminar injection in canine cadavers and compare the injectate distribution between a landmark-guided and an ultrasound-guided thoracolumbar retrolaminar technique using computed tomography. Ten canine cadavers were randomised to receive two injections each of 0.6 mL/kg of iodinated contrast at the level of the twelfth thoracic vertebra (T12): a landmark-guided retrolaminar injection was performed on one hemithorax (group B, n = 10) and an ultrasound-guided on the other hemithorax (group U, n = 10). Groups were compared using the Mann–Whitney U test. The median (range) spread of the contrast in the paravertebral space was 0 (0–3) and 1 (0–5) vertebrae in groups B and U, respectively (p = 0.038). The median (range) extent of the spread surrounding the interverbal foramina was 4 (0–5) in group B and 4 (3–5) in group U. The median (range) spread along the retrolaminar space cranial and caudal to T12 was 3 (0–6) retrolaminar segments in group B and 3 (3–4) in group U. The potential of the ultrasound-guided retrolaminar injection to provide analgesia for dogs suffering from thoracolumbar pain should be further investigated. [ABSTRACT FROM AUTHOR]

Simple Summary: The analgesic management of dogs with spinal disease is important, as insufficient pain relief may result in chronic neuropathic pain. The retrolaminar block is a relatively new local anaesthetic technique, first developed in humans, in which the local anaesthetic is deposited into the musculofascial plane on the lamina of the target thoracic vertebra, thus providing analgesia to the thoracic region. The aim of this study was to evaluate the retrolaminar technique as a peri-operative analgesic option for dogs with spinal disease, by determining the distribution of two volumes of contrast-dye mixture and the potential complications after anatomical landmark-guided thoracolumbar retrolaminar injections in canine cadavers. Eight canine (greyhound) cadavers were randomised into two groups that received either a 10 or a 20 mL injection into the retrolaminar space at the level of the twelfth thoracic vertebra, after which they underwent computed tomography and anatomical dissection to determine the spread of the injectate. The injectate was detected in the surrounding intervertebral foramina and the paravertebral and retrolaminar fascial planes, which could suggest promising analgesic potential for spinal pain. Epidural and retroperitoneal spread was also noted, and the spread was not volume-dependent. Further studies will help to determine the exact indications for this technique. The retrolaminar block is a regional anaesthetic technique, first developed in humans, in which the local anaesthetic is deposited directly onto the dorsal aspect of the thoracic or lumbar vertebral lamina. This study aims to evaluate the distribution of landmark-guided thoracolumbar retrolaminar injections in greyhound cadavers. Thirteen injections of contrast-dye solution were performed in eight cadavers at the level of the twelfth thoracic vertebra (T12), with either 20 mL (n = 8, high volume, HV) or 10 mL (n = 5, low volume, LV) per site. The spread of the injectate was evaluated through computed tomography and transverse anatomical dissection. The groups were compared using the Mann–Whitney U test. The median (range) of the extent of the spread was 4 (2–5) and 3 (2–4) intervertebral foramina in the LV and HV groups, respectively. The median (range) of the spread along the retrolaminar space was 3 (2–3) retrolaminar segments in the LV and 3 (2–4) in the HV group. Epidural and retroperitoneal spread was identified in seven cadavers. Following landmark-guided retrolaminar injections, the injectate spread both in the retrolaminar and paravertebral spaces, without any obvious association between the volume of injectate and the extent of the spread. Further studies are warranted to determine the clinical efficacy of the technique. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar intervertebral disc extrusion is a common neurologic complaint in dogs and is associated with debilitating pain that requires careful analgesic management to avoid the transition to a chronic pain state. Recently, there has been an increased effort to incorporate regional anaesthetic techniques whenever possible, both for perioperative analgesia management and for prevention of chronic pain. A novel regional anaesthetic technique named retrolaminar block is a fascial plane block where the local anaesthetic is injected directly on top of the dorsal aspect of the vertebral lamina, in the fascial plane between the lamina and the epaxial muscles. The technique was recently described in humans and it is claimed to provide analgesia in patients undergoing thoracic and lumbar procedures. To the authors' knowledge, the retrolaminar block has not been previously reported in live dogs. Case presentation: Seven dogs presented to our hospital for suspected thoracolumbar intervertebral disc extrusion were anaesthetised using an anaesthetic premedication and induction protocol tailored for each individual animal. Once the suspected diagnosis was confirmed, all seven dogs were placed in sternal recumbency, and the target thoracolumbar vertebral spinous process was identified with palpation. A unilateral retrolaminar block was performed in all dogs with 2 mg/kg of 0.25% bupivacaine. Physiologic parameters, as well as responses to nociceptive stimuli, were monitored throughout the anaesthetic event. Intraoperatively, one dog required a bolus of fentanyl to control nociceptive stimulation while the epaxial muscles were retracted. No further intraoperative rescue analgesia was required in any of the cases. The postoperative pain was assessed using the Short Form of Glasgow Composite Measure Pain Scale for dogs every four hours for the duration of the dogs' hospitalization. The retrolaminar block reduced the intraoperative requirement for systemic opioids and other adjunct analgesic agents and all dogs were comfortable throughout their hospitalization and up until the time of their discharge. Conclusions: This case report presents the performance of the retrolaminar block technique as part of multimodal analgesia management in seven dogs undergoing thoracolumbar spinal surgery. [ABSTRACT FROM AUTHOR]

Introduction: Retrolaminar block (RLB) is a novel thoracic truncal block for analgesia for the thoracic and abdominal walls. However, the analgesic efficacy of RLB in patients undergoing selective lumbar herniectomy is not well known. The aim of this study is to determine the analgesic efficacy of RLB by measuring the pain intensity of patients with the Numeric Pain Rating Scale and evaluating the non-steroid anti-inflammatory drugs and opioid consumption after the surgery. Methods: Thirty patients with the American Society of Anesthesiologists physical status 1, 2, and 3 undergoing lumbar herniectomy of less than three levels between June 2019 and December 2019 were included in the study. The patients were evaluated in two groups: the RLB group (group R, n=15) and the intravenous (IV) analgesics group (group C, n=15). 10 mL 0.25% bupivacaine was applied bilaterally at the RLB. Tenoxicam, tramadol, and aldolan were administered as post-operative IV analgesic treatment. Numeric Rating Scale scores were evaluated at 2, 8, 12, 24, and 48 h after the surgery. Ketorolac and opioid consumption were evaluated at 24th and 48th h. Results: Compared with group C, group R exhibited lower pain scores at 2, 8, 12, and 24 h postoperatively (p<0.05 for each). Tenoxicam and tramadol doses at 24 and 48 h were lower in group R than the group C (p<0.05 for each). Discussion and Conclusion: The retrolaminar block is an effective technique for post-operative analgesia in patients undergoing selective lumbar herniectomy within the first 24 h without significant complication. [ABSTRACT FROM AUTHOR]

Vicko Gluncic,1 Lara Bonasera,1 Sergio Gonzalez,1 Ivan Krešimir Lukić,2 Kenneth Candido1 1Department of Anesthesia, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA; 2Bjelovar University of Applied Sciences, Bjelovar, HR-43000, CroatiaCorrespondence: Vicko GluncicDepartment of Anesthesia Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL, 60657, USATel +1-203-500-5902Email vicko.gluncic@gmail.comAbstract: Multiple vertebral compression and rib fractures in elderly patients with pre-existing chronic obstructive pulmonary disease is a common scenario associated with significant morbidity and mortality. Severe pain prevents normal ventilation and leads to atelectasis, consolidation, and pneumonia. Subsequently, these patients frequently develop respiratory failure and require intubation and critical care. Therefore, adequate analgesia is often a life-saving intervention. Anesthetic management of a 78-year-old kyphotic patient with T6, T7, and T9 rib fractures on the right and T10– 12 vertebral compression fractures sustained in an accidental fall is presented. She had inadequate pain control and was unable to take a deep breath or cough. Her respiratory status was deteriorating, with tachypnea and worsening hypoxia, necessitating bi-level positive airway pressure (BiPAP) support. Since thoracic epidural analgesia was contraindicated owing to compressive vertebral fractures and to the pending respiratory failure, we opted for a unilateral erector spinae plane (ESP) block at the T7 level and bilateral retrolaminar (RL) blocks at the T10 level. Following the procedure, the pain was immediately relieved and the patient was able to take deep breaths. Shortly thereafter, her respiratory status improved, with the respiratory rate coming back close to the baseline. The patient was subsequently weaned from BiPAP support and discharged from the intensive care unit. While the combination of ESP and RL blocks is not routinely used in patients with multiple rib and vertebral compression fractures, our report indicates that it may be an excellent alternative for analgesia in situations where thoracic epidural and/or paravertebral blocks are contraindicated and when timely intervention could be potentially life-saving.Keywords: erector spinae plane block, retrolaminar block, rib fractures, vertebral compression fracture, case report

Dexing Liu,1,2 Xinpeng Xu,2 Yuhang Zhu,2 Xingxing Liu,1,2 Faliang Zhao,1,3 Guobiao Liang,1,3 Zhaoqiong Zhu1,2 1Soochow University Medical College, Suzhou, 215000, People’s Republic of China; 2Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People’s Republic of China; 3Department of Urology, Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, People’s Republic of ChinaCorrespondence: Zhaoqiong Zhu Email ganzhuzhaoqiong@hotmail.comPurpose: Ultrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy.Patients and Methods: One hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted.Results: Patients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels.Conclusion: Ultrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors.Trial Registration: China Clinical Trials Registration Center (http://www.chictr.org.cn, No. ChiCTR1800017526, Date of registration: 2018– 08-02).Keywords: ultrasound guidance, retrolaminar block, retroperitoneal laparoscopic nephrectomy, local infiltration anesthesia

Background: In daily surgical practice, inguinal hernioplasty is a frequent procedure that is frequently accompanied by severe postoperative pain. Multiple regional blocks have been described for analgesia after such operations. Retrolaminar block (RLB) is a paravertebral block (PVB) variant that provides excellent analgesia and reduces the risk of complications. This prospective trial compared the analgesic efficacy of PVB and RLB in the inguinal hernioplasty., Methods: The 56 patients included were randomly assigned into two equal groups according to the block performed under ultrasound guidance at the T12 level: PVB group (28 patients) and RLB (28 patients). Time until the first rescue analgesia was our primary outcome. Other outcomes included the time to perform the block, changes in intraoperative hemodynamic parameters, postoperative VAS, 24-h morphine consumption, the level of patient satisfaction, and the incidence of block-related complications., Results: Demographic data were comparable in the two groups. However, the time needed for the block was significantly shortened with the RLB (p < 0.001). Patients in the PVB groups expressed better pain scores and lower opioid consumption. Additionally, the time to the first call for opioid analgesia showed a significant prolongation in association with the PVB. There was no discernible difference in the frequency of adverse events and recorded MAP and HR., Conclusion: The PVB has a superior perioperative analgesic profile compared to the RLB, which manifested in the prolonged duration to the first rescue analgesics, better pain scores, and less opioid consumption, with no significant increase in block-related complications., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: The newly introduced erector spinae plane block (ESPB) has given anesthesiologists an alternative regional anesthetic technique for thoracic analgesia. Although ESPB and retrolaminar block (RLB) have similar puncture sites, no clinical study comparing ESPB and RLB has been reported. The aim of this study was to compare ESPB and RLB in terms of analgesic efficacy in the context of multimodal analgesia following breast surgery. Methods: Fifty female patients undergoing breast surgery under general anesthesia were randomly allocated to receive either ultrasound-guided ESPB or RLB with 20 mL of 0.375% levobupivacaine for postoperative analgesia. The primary outcome was analgesic efficacy in terms of time to first postoperative rescue analgesic after the block procedure. The secondary outcomes were consumption of remifentanil during anesthesia, pain intensity at rest for 24 h postoperatively, and occurrence of postoperative nausea and vomiting (PONV). Results: After excluding five patients, 45 patients (22 and 23 patients in the ESPB and RLB group, respectively) were analyzed. Median time until the first postoperative rescue analgesic after the block procedure in the ESPB group was not significantly longer than that in the RLB group (8.6 [range 2.7–24] vs. 4.8 [3.0–24] h; P = 0.83). There was no significant difference in the consumption of remifentanil during anesthesia, pain intensity at rest for 24 h postoperatively, and occurrence of PONV between the two groups. Conclusion: ESPB is equivalent, and not superior, to RLB for postoperative analgesia after breast surgery when 20 mL of 0.375% levobupivacaine is injected at the fourth thoracic vertebra. [ABSTRACT FROM AUTHOR]

Retrolaminar block (RLB) has developed as a safer and easier alternative to paravertebral block (PVB). We hereby present a case of inadvertent complication of pneumothorax after administration of blind retrolaminar block. The detection of pneumothorax was made post-operatively by Point of Care Ultrasound (POCUS). Immediate rescue management was done by giving ipsilateral phrenic nerve block. The uplifting of diaphragm due to paralysis causes a reduction in chest volume, promoting the symphysis of two pleura and sealing of air leaks from lung. This appears to be an effective way to manage mild to moderate pneumothorax without intercostal chest tube drain (ICD) insertion. [ABSTRACT FROM AUTHOR]

Purpose: Retrolaminar block (RLB) is a thoracic truncal block that can produce analgesia for the thoracic and abdominal wall. However, the characteristics of RLB are not well known. The aim of this study was to determine analgesic efficacy by measuring postoperative consume of patient-controlled analgesia (PCA), additional nonsteroidal antiinflammatory drug (NSAID) rescue, and opioid rescue. Our secondary analysis included assessment of the chronological change in arterial levobupivacaine concentrations after the block. Methods: This prospective, randomized, double-blinded study included 30 patients scheduled for modified radical mastectomy under general anesthesia. The patients were randomized to receive either a landmark-guided RLB or paravertebral block (PVB) catheter placement on T4. Continuous infusion with 4 ml/h of 0.25 % levobupivacaine was started for 72 h, after initial injection of 20 ml 0.375 % levobupivacaine before surgery. Postoperative pain was compared using the amount of block PCA (3 ml 0.25 % levobupivacaine with 30-min lockout), NSAID, and opioid rescue. Arterial blood was sampled for 120 min after the initial injection. Results: The frequency of postoperative block PCA use was significantly high after RLB in 24 h [ p = 0.01; 6 (3-12) vs. 2.5 (0.3-3) times, respectively]. There was no PCA use after 24 h in either group. There was no postoperative opioid rescue use throughout the study. After RLB and PVB, there was no significant difference in T ( p = 0.14; 15 ± 8 vs. 15 ± 8 min, respectively) and C ( p = 0.2; 0.9 ± 0.2 vs. 0.9 ± 0.3 µg/ml, respectively), and all the concentrations were below the threshold of local anesthetic systemic toxicity. Conclusion: Continuous RLB was not inferior to PVB except for the first 24 h, and was satisfactory after mastectomy. RLB showed safe, low peak arterial levobupivacaine concentrations. [ABSTRACT FROM AUTHOR]

Background: Anesthesiologists are always looking for a regional analgesic technique which is easy, safe, has a low complication rate, and provides satisfactory analgesia. A retrolaminar block is a recent modified paravertebral technique for analgesia in  thoracoabdominal procedures with a local anesthetic injected at the retrolaminar site. It has the advantage of being safe and easy compared with traditional thoracic epidural analgesia but is still under investigation., Objective: This study aimed to compare ultrasound-guided bilateral retrolaminar block with ultrasound-guided thoracic epidural analgesia for pain relief after laparoscopic cholecystectomy., Study Design: A prospective randomized double-blinded clinical study., Setting: Academic University Hospitals., Methods: Fifty-two adult patients were randomly allocated into 2 equal groups at the end of the surgery: Group R (n = 26) received a bilateral ultrasound-guided retrolaminar block with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000) in each side. Group T (n = 26) received ultrasound-guided thoracic epidural analgesia with 20 mL of 0.25% bupivacaine and 5 µg/mL adrenaline (1:200000)., Results: The Numeric Rating Scale  scores both at rest and during cough were statistically significantly lower in Group R compared with Group T at 30 minutes and one hour postoperatively. The pain scores were statistically significantly lower for about 4 hours in Group R group compared with 6 hours in Group T. The time for the first call of nalbuphine was highly statistically significantly shorter in Group R group (233.04 ± 5.27 minutes) compared with Group T (353.77 ± 5.16 minutes) (mean difference -120.37, (95% CI,  -123.6 to -117.8) P < 0.001. The total amount of nalbuphine consumption in the first 12 hours was statistically significantly decreased in Group T (17.31 ± 5.52 mg) compared with Group R (27.69 ± 5.52 mg) (Mean difference 10.4, 95% CI  7.3-13.5), P < 0.001. The total number of patients who developed nausea and vomiting were statistically significantly greater in Group T (9 patients) compared with Group R group (3 patients), P = 0.04. Moreover, hypotension was statistically significantly more common among patients in Group T group (10 patients) compared with Group R (3 patients), P = 0.025. Both groups were comparable regarding patient satisfaction., Limitations: There is limited literature in the field of the present study and sensory dermatome assessment, but this does not affect the results as we used an ultrasound-guided technique., Conclusions: A single injection retrolaminar block provides adequate postoperative pain relief for about 4 hours compared with a single shot thoracic epidural that lasts about 6 hours. Patient satisfaction with both techniques was the same; about two-thirds of the patients were satisfied or very satisfied with either block.

Study Objective: Ultrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy.Design: Superiority, prospective, randomized, double-blinded, controlled study.Setting: Operating rooms and wards of Mansoura University Children's Hospital, Egypt.Patients: Sixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled.Interventions: In the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB.Measurements: The primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score.Main Results: The number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group.Conclusion: Retrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy. [ABSTRACT FROM AUTHOR]

Introduction A retrolaminar block (RLB) is a modified paravertebral technique with a local anesthetic injected at the retrolaminar site. The aim of this non-inferiority, parallel-group, prospective, and randomized study was to compare the analgesic efficacy of the paravertebral block (PVB) and RLB after lung surgery. Methods Eligible subjects were patients aged more than 20 years, with American Society of Anesthesiologists physical status Ⅰ or II, who were scheduled to undergo video-assisted thoracoscopic surgery (VATS) or limited thoracotomy because of lung disease. Patients were randomly allocated to receive either a PVB or RLB using a computer-generated sequence and sealed opaque envelopes. The PVB and RLB were induced by injecting 20 mL of 0.50% ropivacaine and 40 mL 0.25% ropivacaine, respectively. As the primary outcome variable, we considered the area under the curve (AUC) of the postoperative pain intensity using the trapezoidal method. Pain intensity was assessed using an 11-point numerical rating scale (NRS). We converted the NRS (0-10) into the visual analog scale (VAS) (0-100 mm) proportionally. We compared the AUC of the converted NRS (AUC-cNRS) on coughing between one and two hours after the operation. The non-inferiority margin was set at 25 mm × h in the AUC-cNRS. Patients and nurses were blinded to group assignments. Secondary outcomes included time to perform the block, NRS for pain intensity at rest and on coughing at one, two, four, 24, and 48 hours after the operation, the incidence of postoperative nausea and vomiting, time to first morphine use after the operation, and cumulative morphine consumption at 24 and 48 hours after the operation. Results In each group, 25 patients were randomized and analyzed. No significant difference in the AUC-cNRS was noted between the groups (P = 0.117). The mean difference in the AUC-cNRS (group RLB minus group PVB) was 13.42 mm × h, 95% confidence interval, -3.48 to 30.32 mm × h. However, when patients with unexpectedly extended skin incision were excluded from the analysis, the AUC-cNRS of group RLB was significantly higher as compared to group PVB (P = 0.0388). The time to perform the block was longer in PVB as compared to the RLB group (P < 0.0001). No significant differences were noted in the remaining secondary outcomes. Conclusion The non-inferiority of RLB as compared to PVB was not confirmed. Though RLB has the advantage of a shorter time to perform, RLB is not recommended for patients undergoing VATS or limited thoracotomy because of lack of efficacy as compared to PVB., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sugiyama et al.)