Case report
The ultimate technique for posterior rib fractures: The parascapular sub-iliocostalis plane block – A series of cases
Una técnica fundamental para las fracturas costales posteriores: el bloqueo paraescapular del plano subiliocostal. Una serie de casos
C.R. Almeida, L. Vieira, B. Alves
, G. Sousa, P. Cunha, P. Antunes
Corresponding author
Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal
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Identification of the lateral border of the iliocostalis muscle and performance of the parascapular sub-iliocostalis plane block. The tendinous insertion of the ILCM at the rib is in the superolateral direction (it should not be confounded with the insertion of the levatore costarum muscles whose insertion is in the inferior-lateral direction). The rhomboid major or minor muscle and the posterior superior serratus muscles are observed between the trapezius muscle and the iliocostalis msucles at upper levels.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: LA, local anesthetic spreading.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C.R. Almeida, L. Vieira, B. Alves, G. Sousa, P. Cunha, P. Antunes" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C.R." "apellidos" => "Almeida" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Vieira" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Alves" ] 3 => array:2 [ "nombre" => "G." 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"apellidos" => "Antunes" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço Anestesiologia do Centro Hospitalar Tondela-Viseu, Viseu, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una técnica fundamental para las fracturas costales posteriores: el bloqueo paraescapular del plano subiliocostal. Una serie de casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1508 "Tamanyo" => 266177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Description of the parascapular sub-iliocostalis plane block performed in patient 3.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">With the patient in a lateral position, with both arms along the body, a high-frequency linear ultrasound probe was placed with a parasagittal orientation, immediately adjacent to the medial scapular border at the level of the edge of the sixth rib level. Identification of the lateral border of the iliocostalis muscle and performance of the parascapular sub-iliocostalis plane block. The tendinous insertion of the ILCM at the rib is in the superolateral direction (it should not be confounded with the insertion of the levatore costarum muscles whose insertion is in the inferior-lateral direction). The rhomboid major or minor muscle and the posterior superior serratus muscles are observed between the trapezius muscle and the iliocostalis muscles at upper levels. Abbreviation: LA, local anesthetic spreading.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Herein, we describe a series of cases involving an alternative analgesic technique, the parascapular sub-iliocostalis plane (PSIP) block for patients suffering from posterior rib fractures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The PSIP block was previously described only as single case report<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> being this report the first case series in posterior rib fracture patients. The PSIP block may be an alternative whenever contraindications for erector spinae plane (ESP) block or paravertebral block (PVB) are present, due to its less action in the anterior spinal nerves or to its less risk of inadvertent neuraxial involvement.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To date there are no studies, neither cadaveric nor clinical, related to mechanism of action and local anesthetic (LA) spread of the PSIP block.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Details about the patients and about patients’ condition, comorbidities, analgesia approach, clinical scenario, progression of the case and outcome are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">The PSIP blocks were performed with the patient lateral decubitus under American Society of Anesthesiologists standard monitoring. A high-frequency linear ultrasound probe (Acuson 300; Siemens, Munich, Germany) was placed in a parasagittal plane orientation to 2<span class="elsevierStyleHsp" style=""></span>cm from the medial scapular border at the level of the edge of the scapula spine under sterile conditions (between the fourth rib level and sixth rib level depending on the location of the posterior rib fractures) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The trapezius, rhomboid major, iliocostal, and intercostal muscles were visualized from the superficial to deep muscular layers cranial to 5th rib; distal to 5th rib only trapezius and iliocostalis muscles are observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A sonovisible 100<span class="elsevierStyleHsp" style=""></span>mm 18<span class="elsevierStyleHsp" style=""></span>G needle (Contiplex S ultra; B. Braun, Melsungen, Germany) was inserted with a cranial to caudal orientation using an in-plane technique and advanced in the iliocostal-intercostal myofascial plane in the vicinity of the rib (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The needle location was confirmed with a 2<span class="elsevierStyleHsp" style=""></span>mL saline solution, after which ropivacaine (Fresenius Kabi Pharma, Santiago de Besteiros, Portugal) was administered (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). A catheter was then inserted 6<span class="elsevierStyleHsp" style=""></span>cm beyond the needle tip and tunneled under the skin. No sensitive alterations were noted in all the patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">During this period, all the patients maintained intravenous conventional analgesia. The patient remained under continuous monitoring of the vital signs in an intermediated care unit.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The PVB and ESP block may promote a central sympathetic blockade that can be associated with significant hypotension and bradycardia, affect ventricular function, and decrease cardiac output, which can increase pulmonary edema and result in worsened dyspnea. Additionally, significant chest wall weakness can arise from these techniques, affecting thoracic expansion and, indirectly, venous return.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">These features may put patients at risk of aggravation of preexisting cardiovascular disease, such as in patient 1 case, or aggravate respiratory distress resulting from concomitant pulmonary contusion, post-traumatic atelectasis, undrained pneumothorax, diaphragmatic paralysis or rupture or when there is a preexisting lung disease, such as in the case of patients 1–4, due to the neuromuscular block that may arise from the ESP block or PVB (the thoracic expansion is less likely to be affected with the PSIP block mainly due to the reduced risk of bilateral block and to the limited action of the PISP block on the spinal nerves in opposition to the ESP block or PVB).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The ESP block and the PVB may be hazardous whenever concomitant brain trauma is present, such as in the case of patient 1 and 3. The presence of sepsis or hemostasis alterations may turn out preferable the placement of a catheter away of the vicinity or the neuraxial region.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Indeed, some studies failed to demonstrate that the ESP block spreads to the paravertebral space,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> whereas others concluded that, beyond the paravertebral compartment, epidural spread is the main component of its analgesic properties.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It has been reported a circumferential epidural spread of LA after an ESP block, which can worsen cardiac condition in high-risk patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Potentially, the PSIP block would provoke less epidural-like effects compared with the ESP block due to a lateral injection point, which lowers the risk of massive epidural/paravertebral spread or bilateral block.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,10</span></a> On the other hand, the epidural spread of LA epidurally or the inadvertent dural puncture or direct epidural injection may affect the intracranial pressure when an ESP or PVB are used.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Rhomboid intercostal blocks have been successfully performed in patients with multiple lateral-posterior rib fractures and other causes of chest wall pain.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">However, in the study by Elsharkawy et al., the staining stopped at the lateral edge of the ESM (iliocostalis muscle) in one-third of the specimens, and in cadavers, no staining was observed to the erector spinae muscle (ESM).<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Therefore, this block may have limited action at the fracture sites medial to the lateral border of the iliocostalis muscle (ILCM), as this muscle may represent an obstacle for the LA present in the sub-rhomboid plane or lateral to the ILCM, preventing its spread to the fractured rib plane below the ESM.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The eventual criticism to this novel technique may be hypothetically related to its nomenclature, nevertheless an Expert Consensus in 2021 (ASRA-ESRA Delphi Consensus)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> stablished the retrolaminar (RL) block as an independent entity from the ESP block: in the RL block the injection is done between the laminae and the ESM, in the latter the injection is done between the transverse process and the ESM; on the other hand, in the PSIP block, the injection is done between the most lateral component of the ESM and the ribs, which lead to completely different properties in terms of dispersion pattern, mode of action, contraindications, benefits and complications comparing to the RL and ESP blocks. Of note, the PSIP block is the only block of this group that does not have any component of the vertebrae as a sono-anatomical reference, which makes it a complete novel technique, as the retrolaminar block is when compared to the ESP block.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The PSIP block has also potential benefit for thoracic spine surgery or trauma, as it was shown in a recent report by Almeida et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> due to its action in the posterior rami of the spinal nerves, with less direct action in the anterior spinal nerves, as such, when concomitant thoracic spinal fractures are present the PSIP block can be an interesting alternative to limit neuroaxial LA spread because meningeal membranes or dura-mater can be disrupted, which can be hazardous and complicate neurological check when the ESP or PVB are used.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In the PSIP block the catheter is placed underneath the ILCM, enhancing the craniocaudal LA spread across the longitudinal myofascial sub-ILCM plane and the deeper spread of LA through the disrupted tissue. The observed significant reduction of pain with motion may be related to the LA spread to deep intercostal layers in the fracture sites, direct infiltration of the fractured bone, and action in the proximal intercostal nerves.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The additional spread along the deep intercostal layers is likely, but LA would not reach easily the paravertebral space. The PSIP block could also spread medially below the ESM to block mainly the posterior spinal nerves, contributing to vertebrae analgesia as it was described by Almeida et al. in a case of thoracic spine fixation surgery.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> It should be emphasized than if concomitant anterior-lateral fractures are present the PSIP block should not be a reliable alternative to the ESP block or the PVB. The clinical scenarios in which the PSIP block, despite lacking significant direct action in the ventral spinal rami, could be preferable to the ESP block or PVB for posterior rib fractures, are expressed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">The PSIP block has now revealed its potential in the small series of cases, further large studies are necessary to confirm our results, but we are very convinced of its merits based on our experience.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1977556" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1700934" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1977555" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1700933" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-20" "fechaAceptado" => "2022-06-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1700934" "palabras" => array:4 [ 0 => "Rib fractures" 1 => "Nerve block" 2 => "Ultrasonography" 3 => "PSIP block" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1700933" "palabras" => array:4 [ 0 => "Fracturas de costillas" 1 => "Bloqueo nervioso" 2 => "Ecografía" 3 => "Bloqueo PSIP" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report retrospectively a series of four cases involving the successful use of the recently described parascapular sub-iliocostalis plane block (PSIP), for lateral-posterior rib fractures.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The efficacy of the PSIP block may potentially depend on different mechanisms of action: (1) direct action in the fracture site by craniocaudal myofascial spread underneath the erector spinae muscle (ESM); (2) spread to deep layers through tissue disruption caused by trauma, to reach the proximal intercostal nerves; (3) medial spread below the ESM, to reach the posterior spinal nerves; and (4) lateral spread in the sub-serratus (SS) plane to reach the lateral cutaneous branches of the intercostal nerves; while avoiding significant negative hemodynamic effects and other possible complications associated to other techniques leading that the PSIP may be considered an alternative in some clinical scenarios to the erector spinae plane block or the paravertebral block.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentamos retrospectivamente una serie de 4 casos en los que se utilizó con éxito el bloqueo paraescapular del plano subiliocostal (PSIP), descrito recientemente, para fracturas costales laterales-posteriores.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La eficacia del bloqueo PSIP puede depender potencialmente de diferentes mecanismos de acción: (1) acción directa en las fractura por la extensión miofascial craneocaudal por debajo del músculo erector de la columna, (2) diseminación a capas profundas a través de la disrupción tisular causada por el traumatismo, para alcanzar los nervios intercostales proximales, (3) extensión medial por debajo del músculo erector de la columna, para alcanzar los nervios espinales posteriores y (4) extensión lateral en el plano subserrato para alcanzar las ramas cutáneas laterales de los nervios intercostales, evitando al mismo tiempo efectos hemodinámicos negativos y otras posibles complicaciones asociados a otras técnicas, lo que hace que el bloqueo PSIP pueda considerarse en algunos escenarios clínicos una alternativa al bloqueo del plano erector de la columna vertebral o al bloqueo paravertebral.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1508 "Tamanyo" => 266177 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Description of the parascapular sub-iliocostalis plane block performed in patient 3.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">With the patient in a lateral position, with both arms along the body, a high-frequency linear ultrasound probe was placed with a parasagittal orientation, immediately adjacent to the medial scapular border at the level of the edge of the sixth rib level. Identification of the lateral border of the iliocostalis muscle and performance of the parascapular sub-iliocostalis plane block. The tendinous insertion of the ILCM at the rib is in the superolateral direction (it should not be confounded with the insertion of the levatore costarum muscles whose insertion is in the inferior-lateral direction). The rhomboid major or minor muscle and the posterior superior serratus muscles are observed between the trapezius muscle and the iliocostalis muscles at upper levels. Abbreviation: LA, local anesthetic spreading.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: PSIP: parascapular sub-iliocostalis plane; NPRS: Numeric Pain Rating Scale; IV: intravenously; NYHA: New York Heart Association; COPD: chronic obstructive pulmonary disease; CAI: community acquired infection; HCAI: healthcare-associated infection.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Trauma \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Technique \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of no conventional analgesia \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conventional analgesia \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evolution/complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Patient 1</span>Male63 years oldNo comorbidities or usual medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fracture of the 4th to 11th costal arches (posterior)Pneumotorax and pulmonary contusionBrain traumaHypoxemia requiring O<span class="elsevierStyleInf">2</span> needinginspiratory fraction of oxygen of 35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4th day of hospitalization<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>PSIP blockPSIP block at the fifth rib level performed with initial bolus of 20<span class="elsevierStyleHsp" style=""></span>mL of ropivacaine 0.5%Initial NPRS 8–9Under systemic analgesia with:- Metamizole 2<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day- Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV- Ketorolac 30<span class="elsevierStyleHsp" style=""></span>mg IV 2 times a day- Meperidine 30<span class="elsevierStyleHsp" style=""></span>mg IV at rescue, as deemed necessary up to 4 times a dayAfter PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>NPRS 4–5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mandatory bolus 4 times a day ropivacaine 0.2% (20<span class="elsevierStyleHsp" style=""></span>mL) until Day 5 of PSIP blockDay 4 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>no need for O<span class="elsevierStyleInf">2</span> supplementation and NPRS 1–2 with forced inspirationDay 6 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>no need for SOS bolus of ropivacaine<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>NPRS 0Day 8 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>No need for rescue medication. Catheter removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 1–Day 5 of PSIP block:-Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day-Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV-Ketorolac 30<span class="elsevierStyleHsp" style=""></span>mg IV 2 times a day-Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 2 times a dayDay 6–Day 7 of PSIP block:-Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day-Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day-No need for rescue medicationDay 8 of PSIP block:-Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a dayNo need for rescue medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambulation after PSIP blockRespiratory kinesiotherapyafter PSIP blockNo adverse effects or epidural-like symptoms. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2Male64 years oldHypertension, dyslipidemia, heart failure (NYHA II), and atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Third to seventh left posterolateral rib fractures, after a fall 5 days earlier.At hospital admission, the blood gas analysis showed hypoxemic respiratory insufficiency (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>150) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1th day of hospitalization<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>PSIP blockPSIP block performed with initial bolus of 30<span class="elsevierStyleHsp" style=""></span>mL of ropivacaine 0.375% at the fourth rib region.Initial NPRS 9Under systemic analgesia with:- Metamizole 2<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day- Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV- Meperidine 30<span class="elsevierStyleHsp" style=""></span>mg IV at rescue, as deemed necessary up to 4 times a dayAfter PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>NPRS 2After PSIP block, the patient reported discrete left thoracic thermal sensitive changes. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">An elastomeric infusion 10<span class="elsevierStyleHsp" style=""></span>mL/h pump (<span class="elsevierStyleItalic">B. Braun</span>) of 0.25% ropivacaine was initiated through the PSIP catheter and maintained for 5 days. (<span class="elsevierStyleItalic">bolus 15</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mL every 6</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">h</span>)The patient maintained significant pain relief at rest and with active mobilization during this period.During this period, the patient required no rescue analgesia, including PSIP block bolus. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 1–Day 5: only infusion 10<span class="elsevierStyleHsp" style=""></span>mL/h pump of 0.25% ropivacaine was initiated through the PSIP catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambulation after PSIP block.No further respiratory distress or aggravation of the cardiac condition was observed during her presence in the ward. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3Female75 years oldComorbidities: varicose veins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fracture of the 6th costal arch (posterior) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st day of hospitalization<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>PSIP block \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mandatory bolus 4 times a day ropivacaine 0.2% (20<span class="elsevierStyleHsp" style=""></span>mL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 1–Day 5 of PSIP block:-Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambulation after PSIP block \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pneumothorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PSIP block performed with initial bolus of 20<span class="elsevierStyleHsp" style=""></span>mL of ropivacaine 0.75% at the sixth rib level \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 5 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>No need for rescue medication. Catheter removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Respiratory kinesiotherapy after PSIP block \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brain traumaHypoxemia requiring O<span class="elsevierStyleInf">2</span>, nasal cannula 2<span class="elsevierStyleHsp" style=""></span>L/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Initial NPRS 9–10Under systemic analgesia with:- Metamizole 2<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day- Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV- Ketorolac 30<span class="elsevierStyleHsp" style=""></span>mg IV 2 times a day- Meperidine 30<span class="elsevierStyleHsp" style=""></span>mg IV at rescue, as deemed necessary up to 4 times a dayAfter PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>NPRS 2–3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 2 times a dayNo need for rescue medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No adverse effects or epidural-like symptoms. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4Male66 years oldCOPD. Diabetes. Medication: budesonide<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>formoterol;metformin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>sitagliptin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fracture of the right 4th to 9th costal arches (posterior)Pulmonary contusionHypoxemia requiring O<span class="elsevierStyleInf">2</span> for needinginspiratory fraction of oxygen of 35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2th day of hospitalization<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>PSIP block (sitting position)PSIP block performed at 5th intercostal space with initial bolus of 20<span class="elsevierStyleHsp" style=""></span>mL ropivacaine 0.375%Initial NPRS: 8Under systemic analgesia with:- Metamizole 2<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day- Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IV- Ketorolac 30<span class="elsevierStyleHsp" style=""></span>mg IV 2 times a day- Meperidine 30<span class="elsevierStyleHsp" style=""></span>mg IV at rescue, as deemed necessary up to 4 times a day30<span class="elsevierStyleHsp" style=""></span>min after bolus<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>NPRS 1 (static pain); 3 (dynamic pain) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mandatory bolus 4 times a day ropivacaine 0.2% 20<span class="elsevierStyleHsp" style=""></span>mL until Day 7 of PSIP block; plus bolus of ropivacaine 0.2% 15<span class="elsevierStyleHsp" style=""></span>mL at rescue, as deemed necessaryDay 1–Day 4 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>VAS 0–1 (static pain); VAS 2–4 (dynamic pain); 1 SOS bolus/dayDay 5–Day 7 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>VAS 0–1 (static pain); VAS 1–2 (dynamic pain); end of O<span class="elsevierStyleInf">2</span> supplementation on D7; no need for rescue bolusDay 8 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>1 rescue bolus of ropivacaine 0.2% 15<span class="elsevierStyleHsp" style=""></span>mLDay 9 of PSIP block<span class="elsevierStyleHsp" style=""></span>→<span class="elsevierStyleHsp" style=""></span>Catheter removal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Day 1–Day 2 of PSIP block:- Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day- Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day- Perfusion of tramadol 300<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IVDay 3 of PSIP block:- Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day- Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 2 times a day- Perfusion of tramadol 200<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h IVDay 4 of PSIP block:- Paracetamol 1<span class="elsevierStyleHsp" style=""></span>g IV 3 times a day- Parecoxib 40<span class="elsevierStyleHsp" style=""></span>mg IV 2 times a day- Metamizole 1<span class="elsevierStyleHsp" style=""></span>g IV 2 times a dayNo need for opioid medication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambulation in Day 3 of hospitalizationGood compliance with respiratory kinesiotherapyafter PSIP blockNo adverse effects or epidural-like symptoms.No evidence of CAI or HCAIDischarge to home on 10th day \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3291729.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Serie of cases of PSIP block.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-traumatic parenchymal pulmonary pathology (atelectasis, contusion, hemorrhage) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-existing lung disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pre-existing neurologic disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Undrained pneumothorax \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemostasis alterations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diaphragmatic rupture \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cardiac insufficiency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concomitant brain trauma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous thoracic spine surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Concomitant spinal trauma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need of neurologic post-traumatic or post-surgical neurological evaluation \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3291730.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patients’ conditions in which the PSIP block could be less hazardous than the ESP block or the PVB for posterior rib fractures analgesia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parascapular sub-iliocostalis plane block: comparative description of a novel technique for posterior rib fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.R. Almeida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/papr.13003" "Revista" => array:6 [ "tituloSerie" => "Pain Pract" "fecha" => "2021" "volumen" => "21" "paginaInicial" => "708" "paginaFinal" => "714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33586285" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can unilateral erector spinae plane block result in bilateral sensory blockade?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Tulgar" 1 => "O. Selvi" 2 => "A. Ahiskalioglu" 3 => "Z. Ozer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-019-01402-y" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2019" "volumen" => "66" "paginaInicial" => "1001" "paginaFinal" => "1002" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31114943" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound guided erector spinae plane block as a cause of unintended motor block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Selvi" 1 => "S. Tulgar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2018" "volumen" => "65" "paginaInicial" => "589" "paginaFinal" => "592" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral erector spinae plane block (ESPB) epidural spread" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Schwartzmann" 1 => "P. Peng" 2 => "M. Antunez Maciel" 3 => "M. Forero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/rapm-2018-000030" "Revista" => array:5 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2019" "volumen" => "44" "paginaInicial" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30640666" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral thoracic paravertebral block: potential and practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Richardson" 1 => "P.A. Lonnqvist" 2 => "Z. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 23 | 7 | 30 |
| 2024 September | 46 | 19 | 65 |
| 2024 August | 45 | 22 | 67 |
| 2024 July | 39 | 1 | 40 |
| 2024 June | 24 | 8 | 32 |
| 2024 May | 27 | 13 | 40 |
| 2024 April | 4 | 2 | 6 |
| 2024 February | 1 | 6 | 7 |
| 2024 January | 4 | 1 | 5 |
| 2023 December | 8 | 0 | 8 |
| 2023 November | 20 | 2 | 22 |
| 2023 October | 53 | 31 | 84 |
| 2023 September | 3 | 3 | 6 |
| 2023 August | 2 | 4 | 6 |
| 2023 July | 1 | 3 | 4 |
| 2023 June | 3 | 1 | 4 |
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