🔥🫁 "Pain at the Core: On-Arrival Blocks for Chest and Abdomen" 🧍‍♂️🛡️ #PainAtTheCore #OnArrivalBlock #TruncalAnalgesia #ChestWallBlock #AbdominalBlock #RegionalAnesthesia #ESPBlock #TAPBlock #SAPBlock #UltrasoundGuidedRA #PointOfCareBlocks #OnArrivalRA #TipoftheDay #MyRATips Tip of the Day: 🟦 Why FOCUS on Truncal Pain Early? 🫁 Chest and abdominal injuries often compromise vital functions - especially breathing, coughing, and cooperation. 🔥 Pain in these regions is often deep, diffuse, and distressing, and opioids alone may not suffice or may cause respiratory depression. 🛠️ Regional blocks offer site-specific, opioid-sparing relief that improves immediate care and downstream outcomes. 🟨 CLINICAL GOALS of Truncal On-Arrival Blocks 🫁 Restore respiratory efficiency (chest trauma, rib fractures) 🚑 Facilitate imaging, positioning, and transport 🧘 Relax abdominal guarding (peritonitis, pancreatitis) 📉 Reduce sympathetic overdrive in trauma 🫱 Enhance cooperation for procedures or airway planning 🟫 COMMON INDICATIONS 🟦 Chest Wall: Rib fractures (especially multiple) Flail chest Post-thoracostomy or chest tube placement Chest wall contusions in blunt trauma 🟨 Upper Abdomen: Blunt abdominal trauma Acute pancreatitis Upper GI perforation or distension Postoperative laparotomy or laparoscopy pain 🟧 Lower Abdomen: Inguinal hernia (painful or strangulated) Appendicitis with guarding Abdominal wall hematomas or incisional pain 🟪 BEST CHOICES 🫁 For Chest Wall Injuries: ESPB, SAPB, or ICNB. Provide broad dermatomal coverage. Safe to perform away from critical structures like the pleura. Ideal for rib fractures, flail chest, and chest tube insertion pain. 🧼 For Upper Abdominal Pain: ESPB at T6–T9 levels or TAP Block. Relieve guarding and improve respiratory effort in conditions like pancreatitis or blunt abdominal trauma. 🧩 For Lower Abdominal Conditions: TAP Block, RSB, IIN/IHN Block. Provide localized anterior abdominal wall analgesia. Suitable for inguinal hernia, appendicitis, or post-incisional pain. 🟥 ESPB: CHAMPION? ✅ Superficial and safe (away from pleura/major vessels) ✅ Wide craniocaudal spread ✅ Suitable for non-sterile or semi-sterile environments ✅ Excellent for rib fractures and abdominal wall pain ✅ Can be done quickly with or without USG 🟧 KEY PEARLS 🧼 Basic aseptic precautions suffice in emergency use 🩻 USG is ideal but can be landmark-based if skilled 🧾 Document block site, volume, drug, and response ⏱️ Reassess for conversion to longer-acting block or catheter if needed 🟫 CHEST WALL BLOCKS: RULE “Hit the Rib, Deposit the Drug” 🔹Deep SAP Block – Needle hits the rib, inject deep to serratus 🔹External Oblique Intercostal Plane Block – Target rib at anterior/mid-axillary line, inject above EO 🔹Parasternal Block – Identify rib near sternum, inject in intercostal plane 🎯A safe, reproducible approach - perfect for emergency or limited-resource settings. 🟨 ABDOMINAL WALL BLOCKS: RULE “Follow the Muscle, Find the Plane” 🔹TAP Block – Feel or visualize the abdominal wall → insert between internal oblique & transversus abdominis 🔹Rectus Sheath Block – Palpate the rectus muscle → inject posterior to it, above posterior sheath 🔹Ilioinguinal/Iliohypogastric Block – Palpate ASIS → inject in plane between internal oblique and transversus abdominis near the iliac crest 🎯Key Tip: Identify the muscle → follow its plane → deposit where spread flows freely. ✅Reliable, reproducible, and effective for anterior abdominal wall analgesia. "When pain impairs breathing or masks diagnosis, a timely On-Arrival Block for the trunk may be your best intervention - not just for comfort, but for survival."

Tip of the Day "Where It Starts, It Spreads: Chest Wall Blocks Decoded" #RegionalAnesthesia #ChestWallBlocks #UltrasoundGuidedBlocks #AnatomyMatters #BlockSpread #PecsBlock #SAPBlock #PainManagement #AnesthesiaTips Always know the origin and insertion of the muscle where local anesthetic (LA) is deposited during chest wall blocks. The anatomical extent of that muscle largely determines the dermatomal coverage of the block. For example: Pectoralis Major extends only to the 6th rib, typically providing coverage from T2 to T6. Serratus Anterior originates as far as the 9th rib, allowing the SAP block to cover T3 to T9. Understanding muscle anatomy is key to predicting block spread and optimizing analgesia. By Dr. Kartik Sonawane

Unsure if SAPblock will adequately cover posterior aspects of thorax (I suspect there is some “bucket handle” motion/stretching in deployment of Nuss bar).

A thumb dislocation, a Shoulder and Hip dislocation, 2x Sedations for ankles, STEMI with cardiogenic shock and APO,a cardiac arrest, a case of Lemierre's disease, atypical presentation PE with RHS and 2x FIBs SAPblock in 4 nights. EM is definitely my favourite speciality.

Another nice video from @anesthesiadocmd. This time #SAPblock 👇👇👇 @ATICS_SHSCT @NIRASociety @SKARA_SSAIM

Excellent to see this now in print @veenith_tonny @DrEVBeard @carl_hillermann @suemillerchip. Hopefully the evidence for the fascial plane blocks will continue to grow. #ribfractures #SAPblock