IntroductionThe success of ultrasound-guided regional anaesthesia depends on the acquisition and interpretation of optimal ultrasound images. This study aimed to develop an assessment tool to evaluate proficiency in interpreting ultrasound images for regional anaesthesia.MethodsThis study involved domain and item generation; preliminary testing; and content validity evaluation by an expert panel review. Questions were generated by the study group and pilot testing was conducted with UK-based anaesthesia consultants and resident doctors. Face validity was tested by thematic analysis of participant feedback questionnaires, discriminative ability using Rasch modelling of item response and internal reliability using Cronbach's alpha method.ResultsA 57-item pilot test was completed by 43 participants across clinical experiences from stage 1 training to consultant. Median (IQR [range]) completion time was 55 (41-64 [29-94]) min and fatigue point was question 49 of 57 (37-57 [15-57]). Rasch analysis led to the exclusion of seven items and content validity evaluation resulted in the removal of a further six items, resulting in a 44-item question set. The test showed good face validity, with a Cronbach's alpha of 0.92, indicating high internal reliability.DiscussionThis study produced a 44-item assessment tool to assess the proficiency of ultrasound image interpretation in regional anaesthesia for a range of upper limb, lower limb and truncal blocks, with proven face validity, internal reliability and content validity. Further testing with a larger sample is planned to verify reliability and validity, with the hope that this may be an asset for regional anaesthesia training and assessment.

The sacral erector spinae plane (S-ESP) block is a recently described regional anesthesia technique that targets sacral dermatomes. First reported in 2019, it has been increasingly explored as a potential option for perioperative analgesia in surgeries involving the sacral, perineal, and pelvic regions. This review aims to summarize and critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block, outlining its mechanisms of action, approaches, efficacy, and safety while identifying research gaps and future directions. We performed a narrative review integrating anatomical descriptions, sonographic techniques, and available randomized controlled trials (RCTs) evaluating the clinical efficacy of the S-ESP block. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Ovid (Medline) from inception to July 21, 2025, without language or date restrictions. Full-text RCTs investigating ultrasound-guided S-ESP blocks for perioperative analgesia were reviewed and summarized. Fourteen RCTs (published 2023–2025) were included, conducted predominantly in Turkey, India, and Egypt, spanning pediatric (6 months to 12 years) and adult populations undergoing circumcision, hypospadias repair, hemorrhoidectomy, pilonidal sinus surgery, transurethral resection of prostate, lumbar discectomy, and total hip arthroplasty. Most pediatric trials compared midline S-ESP with caudal or penile blocks, generally demonstrating a longer time to first rescue analgesia and reduced postoperative analgesic consumption, although one study reported a superior duration with caudal block. In adults, the S-ESP block consistently reduced pain scores and opioid requirements. Current evidence suggests that both midline and paramedian S-ESP techniques are technically feasible, appear safe in the short term, and provide clinically relevant postoperative analgesia in selected pediatric urogenital, adult anorectal, and orthopedic surgeries. However, heterogeneity in techniques, small single-center samples, and a narrow range of indications limit its generalizability. Large, multicenter RCTs with standardized protocols are needed to clarify the optimal approaches, dosing strategies, and comparative role of S-ESP block versus established neuraxial and peripheral techniques.

Editor—We commend the efforts of Casas-Arroyave and colleagues1 for comparing the efficacy of i.v. lidocaine with thoracic epidural analgesia (TEA) in a multicentre RCT. They concluded that i.v. lidocaine was non-inferior to TEA.Click or tap here to enter text. However, we note that their conclusions face challenges in terms of data support, given that the upper limit of the 95% confidence interval (CI) for the primary outcome measure, the numerical pain rating (NPR) scale on movement, encompasses the prespecified non-inferiority margin of one point on the NPR scale.

Background Inconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks. Methods We performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as >= 75% agreement and weak consensus as 50%-74% agreement. Results A total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research. Conclusions We achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care.

Editor—Fascial plane blocks show variable efficacy. Spread of local anaesthetic is unpredictable, yet physical mechanisms have not been investigated. 1 Chin K.J. Lirk P. Hollmann M.W. Schwarz S.K.W. Mechanisms of action of fascial plane blocks: a narrative review. Reg Anesth Pain Med. 2021; 46: 618-628 Google Scholar ,2 Chin K.J. El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Can J Anaesth. 2021; 68: 387-408 Google Scholar There is a need to understand how fascial plane blocks both work and fail to guide clinical practice and research. 3 Black N.D. Stecco C. Chan V.W.S. Fascial plane blocks: more questions than answers?. Anesth Analg. 2021; 132: 899-905 Google Scholar ,4 McLeod G. Zihang S. Sadler A. et al. Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection. Reg Anesth Pain Med. 2021; 46: 540-548 Google Scholar We hypothesised that: (1) injection through single-bevelled needles generate higher pressures than through Tuohy needles; (2) higher pressures are associated with reduced tissue displacement; (3) fascial penetration meets with a wide range of needle-tip insertion forces; and (4) the soft-embalmed Thiel cadaver is a robust model of repeated injection. Our primary objective was to compare fluid injection pressures after injection of a 5 ml bolus of embalming fluid over a range of fascial planes and cadavers using a 20 G short-bevelled block needle and an 18 G Tuohy needle at two injection rates: 20 and 30 ml min−1.

Editor—We read with great interest the randomised controlled trial comparing serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair. 1 Alfirevic A. Marciniak D. Duncan A.E. et al. Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trial. Br J Anaesth. 2023; 130: 786-794 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Performing such a large trial is very laborious and the authors are to be complimented for their scientific thoroughness. The literature on fascial plane blocks is cluttered with case series, retrospective data, and inadequately performed research. 2 Haskins S.C. Memtsoudis S.G. Fascial plane blocks for cardiac surgery: new frontiers in analgesia and nomenclature. Anesth Analg. 2020; 31: 125-126 Crossref Scopus (7) Google Scholar ,3 Tran D.Q. Boezaart A.P. Neal J.M. Fascial plane blocks: the next leap. Reg Anesth Pain Med. 2021; 46: 568-569 Crossref PubMed Scopus (3) Google Scholar We are therefore delighted to see a well-conducted trial contradicting the increasingly popular beliefs that fascial plane blocks should always be added to a standard multimodal analgesia protocol in cardiac surgery. 4 Jack J.M. McLellan E. Versyck B. Englesakis M.F. Chin K.J. The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery, thoracic surgery and trauma: a qualitative systematic review. Anaesthesia. 2020; 75: 1372-1385 Crossref PubMed Scopus (59) Google Scholar , 5 Hoogma D.F. Van den Eynde R. Al Tmimi L. et al. Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: results of a double-blind, prospective randomized placebo-controlled trial. J Clin Anesth. 2023; 86111072 Crossref PubMed Scopus (11) Google Scholar , 6 Hoogma D.F. Van den Eynde R. Oosterlinck W. et al. Erector spinae plane block for postoperative analgesia in robotically-assisted coronary artery bypass surgery: results of a randomized placebo-controlled trial. J Clin Anesth. 2023; 87111088 Crossref PubMed Scopus (11) Google Scholar As most single-shot fascial plane blocks offer analgesic effects (if at all) only for up to 6 h (and very optimistically 12 h), 7 Kim D.H. Kim S.J. Liu J. Beathe J. Memtsoudis S.G. Fascial plane blocks: a narrative review of the literature. Reg Anesth Pain Med. 2021; 46: 600-617 Crossref PubMed Scopus (20) Google Scholar the attempt to prolong the analgesic effects by using liposomal bupivacaine as an alternative to catheter placement is potentially interesting. 8 Kelava M. Alfirevic A. Bustamante S. Hargrave J. Marciniak D. Regional anesthesia in cardiac surgery: an overview of fascial plane chest wall blocks. Anesth Analg. 2020; 131: 127-135 Crossref PubMed Scopus (101) Google Scholar Serratus anterior and pectoralis plane blocks for robotically assisted mitral valve repair: a randomised clinical trialBritish Journal of AnaesthesiaVol. 130Issue 6PreviewMinimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics. Full-Text PDF

Study design Prospective randomized placebo controlled double blind trial. Objective To examine the effect of ESP block after minimally invasive posterior stabilization for vertebral fractures on opioid consumption, pain, blood loss, disability level, and wound healing complications. Methodology Patients indicated for minimal invasive posterior stabilisation were included to the study. Our primary outcome was the opioid consumption and Visual Analogue Scale (VAS) measured during the first 48 hours. Secondary outcomes used to measure the short-term outcome included Oswestry Disability Index (ODI) and Patient Reported Outcome Spine Trauma (PROST). Results In total, 60 patients were included with a 93.3% follow-up. Average morphine consumption during the PACU (Post Anaesthesia Care Unit) period was 5.357 mg in ESP group and 8.607 mg in placebo group (P = .004). Average VAS during first 24 hour was 3.944 in ESP group and 5.193 in placebo group (P = .046). Blood loss was 14.8 g per screw in ESP group and 15.4 g in placebo group (P = .387). The day2 PROST value was 33.9 in ESP group and 28.8 in placebo group (P = .008) and after 4 weeks 55.2 in ESP group and 49.9 in placebo group (P = .036). No significant differences in ODI were detected. Conclusion The use of ESP block in minimally invasive spinal surgery for posterior fracture stabilization leads to a significant reduction of opioid consumption during PACU stay by 37.7%. Reduction of opioid consumption was accompanied with lower pain (VAS). We found positive effect of the ESP block on short term outcome scores, but no effect on perioperative blood loss and wound healing.

Background and objectives Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement. Results Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

BACKGROUND/IMPORTANCE:There is heterogeneity among the outcomes used in regional anesthesia research.OBJECTIVE:We aimed to produce a core outcome set for regional anesthesia research.METHODS:We conducted a systematic review and Delphi study to develop this core outcome set. A systematic review of the literature from January 2015 to December 2019 was undertaken to generate a long list of potential outcomes to be included in the core outcome set. For each outcome found, the parameters such as the measurement scale, timing and definitions, were compiled. Regional anesthesia experts were then recruited to participate in a three-round electronic modified Delphi process with incremental thresholds to generate a core outcome set. Once the core outcomes were decided, a final Delphi survey and video conference vote was used to reach a consensus on the outcome parameters.RESULTS:Two hundred and six papers were generated following the systematic review, producing a long list of 224 unique outcomes. Twenty-one international regional anesthesia experts participated in the study. Ten core outcomes were selected after three Delphi survey rounds with 13 outcome parameters reaching consensus after a final Delphi survey and video conference.CONCLUSIONS:We present the first core outcome set for regional anesthesia derived by international expert consensus. These are proposed not to limit the outcomes examined in future studies, but rather to serve as a minimum core set. If adopted, this may increase the relevance of outcomes being studied, reduce selective reporting bias and increase the availability and suitability of data for meta-analysis in this area.

Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for "block view" (which visualizes the block site and is maintained for needle insertion/injection). A "strong recommendation" was made if ≥75% of participants rated any structure as "definitely include" in any round. A "weak recommendation" was made if >50% of participants rated it as "definitely include" or "probably include" for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a "strong recommendation" was made for 60 structures on orientation scanning and 44 on the block view. A "weak recommendation" was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.

BackgroundThere is heterogeneity in the names and anatomical descriptions of regional anesthetic techniques. This may have adverse consequences on education, research, and implementation into clinical practice. We aimed to produce standardized nomenclature for abdominal wall, paraspinal, and chest wall regional anesthetic techniques.MethodsWe conducted an international consensus study involving experts using a three-round Delphi method to produce a list of names and corresponding descriptions of anatomical targets. After long-list formulation by a Steering Committee, the first and second rounds involved anonymous electronic voting and commenting, with the third round involving a virtual round table discussion aiming to achieve consensus on items that had yet to achieve it. Novel names were presented where required for anatomical clarity and harmonization. Strong consensus was defined as ≥75% agreement and weak consensus as 50% to 74% agreement.ResultsSixty expert Collaborators participated in this study. After three rounds and clarification, harmonization, and introduction of novel nomenclature, strong consensus was achieved for the names of 16 block names and weak consensus for four names. For anatomical descriptions, strong consensus was achieved for 19 blocks and weak consensus was achieved for one approach. Several areas requiring further research were identified.ConclusionsHarmonization and standardization of nomenclature may improve education, research, and ultimately patient care. We present the first international consensus on nomenclature and anatomical descriptions of blocks of the abdominal wall, chest wall, and paraspinal blocks. We recommend using the consensus results in academic and clinical practice.

The ultrasound-guided erector spinae plane (ESP) block has been recently described for postoperative analgesia after various thoracic and abdominal surgeries, mostly laparoscopic. Some authors suggest that the ESP block has an effect on both visceral and somatic pain. We describe the successful use of continuous ESP block using intermittent boluses via catheter in open cholecystectomy (OC). Our patient was scheduled for laparoscopic cholecystectomy, which unexpectedly led to open procedure. Continuous ESP block provided good analgesia for 96 h after surgery. To our knowledge, this is the first case report of the use of continuous ESP block using intermittent boluses for OC.