Top Tweets for #ESPb
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๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐: ๐๐๐ ๐๐๐
๐๐๐ ๐๐๐ ๐๐๐๐๐
#RibFractureAnalgesia #RegionalAnaesthesia #PainMedicine #AcutePain #TraumaPain #ChestWallBlocks #ESPB #SAPB #IntercostalNerves #PainGenerator #DynamicPain #OpioidSparingAnalgesia #GrayZoneInRA #GrayAreasInRA
๐๐๐๐ ๐๐๐๐๐ ๐ข๐ง ๐๐:
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Rib fractures are not rare injuries.
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They account for nearly 10% of trauma admissions & may be seen in up to 39% of blunt thoracic trauma.
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Real challenge is not only the fracture.
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It is the pain-driven respiratory compromise that follows.
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Before choosing a block, we must understand the anatomy.
1๏ธโฃ ๐ง ๐๐๐ ๐๐๐๐ ๐๐๐๐๐๐ ๐๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐
โซ๏ธ Ribs are mainly supplied by intercostal nerves, which are anterior rami of thoracic spinal nerves.
โซ๏ธ Pain also comes from periosteum, collateral branches, lateral cutaneous branches, intercostal muscles, endothoracic fascia, and exothoracic fascia.
โซ๏ธ So rib fracture pain is not one nerve, one rib, or one simple pathway.
2๏ธโฃ ๐ฆด ๐
๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐
โซ๏ธ Posterior / posterolateral fractures may have stronger posterior chest wall and paraspinal contribution.
โซ๏ธ Lateral / anterolateral fractures commonly involve lateral cutaneous and intercostal territories.
โซ๏ธ Anteromedial fractures may require anterior intercostal or parasternal coverage.
โซ๏ธ Multilevel or bilateral fractures may need broader neuraxial or paravertebral strategies.
3๏ธโฃ ๐ฏ ๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐ ๐๐ ๐๐๐ ๐๐๐๐๐๐๐๐๐
โซ๏ธ ESPB may be a selective option for posterior or posterolateral rib fractures.
โซ๏ธ SAPB may be more anatomically congruent for lateral and anterolateral rib fractures.
โซ๏ธ Parasternal / anterior intercostal approaches may be useful for anteromedial pain.
โซ๏ธ Thoracic paravertebral or epidural analgesia may provide broader coverage when clinically appropriate.
4๏ธโฃ โ ๏ธ ๐๐๐ ๐๐๐ ๐๐๐๐๐๐ ๐๐๐ ๐๐๐๐๐๐๐๐๐๐๐๐๐๐๐ ๐๐๐๐
โซ๏ธ ESPB is a posterior fascial plane technique.
โซ๏ธ Dorsal ramus involvement is more consistent.
โซ๏ธ Ventral ramus, paravertebral, or epidural spread may be variable.
โซ๏ธ Central convergence of pain does not mean all peripheral blocks behave equally.
5๏ธโฃ ๐ซ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐ ๐๐ ๐
๐๐๐๐๐๐๐๐๐
โซ๏ธ Deep inspiration
โซ๏ธ Effective cough
โซ๏ธ Dynamic pain during movement
โซ๏ธ Physiotherapy participation
โซ๏ธ Incentive spirometry performance
โซ๏ธ Pneumonia prevention
โซ๏ธ Delirium and functional recovery
6๏ธโฃ ๐ ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐ ๐ ๐๐๐
๐๐๐ ๐๐๐๐
โซ๏ธ It is controlled systemic local anesthetic exposure.
โซ๏ธ It may modulate neuronal excitability and central sensitization.
โซ๏ธ Elderly trauma patients may have a narrower therapeutic margin.
โซ๏ธ LAST monitoring should be systematic, not casual.
โ
๐๐๐ ๐๐๐๐๐๐๐๐๐
โซ๏ธ Map the fracture.
โซ๏ธ Identify the neural territory.
โซ๏ธ Understand the block mechanism.
โซ๏ธ Choose the technique accordingly.
๐ซ One-size-fits-all analgesia may miss the dominant pain generator.
๐ฆด Rib fracture analgesia is not just about blocking pain - it is about restoring breathing, coughing, mobilization, and recovery.
Happy Guru Purnima to everyone โค๏ธ
๐๐ฅ Hot off the press!
Link: https://t.co/kA7llBSrgZ
๐จโจ Thrilled to share our latest publication in @IJA_web ! ๐ฎ๐ณ๐
A comprehensive overview of the trends and types of articles published from ๐ฎ๐ณ on #ESPB #RegionalAnaesthesia! ๐ฌ๐ฅ
@IJA_web @ISANHQ recorded the highest number of publications and citations on #ESPB by Indian Authors. ๐
Thanks @loinabhi and @DrRakeshGarg8 for this wonderful opportunity ๐๐ป๐๐ป
Honored to contribute to this movement in #ESPB and #RA! ๐ช๐ฉบ๐โจ
#ESPB #RegionalAnaesthesia #India #RegionalAnalgesia #SpineSurgery #PCNL #MedTwitter
Glad to see the daring discourse on axonal sensitivity and block dynamics related to ESPB by Prof Wildsmith himself !!๐We're currently crafting our responseโstay tuned!
#ESPB
@KalagaraHari @Ropivacaine @anesthesiadocmd @Bubu84csa @Steve_Coppens @RAPMOnline
Nuestro gerente de la Empresa de Servicios Pรบblicos de Boyacรก, ing. Robinson Larrotta, acompaรฑรณ el Comitรฉ Departamental de Gestiรณn del Riesgo.
De esta manera, desde la #ESPB seguimos aportando a la consolidaciรณn de nuestra #BoyacรกGrande.๐๐๐ค
Nuestro gerente Robinson Larrotta y el equipo de trabajo de la #ESPB se reunieron con el gerente de Empoduitama SA ESP Alejandro Mariรฑo en mesa de seguimiento a proyectos en el Plan Departamental de Aguas.
#Duitama
#ElAguaEsVital
#BoyacรกGrande๐๐๐ค
Desde la #ESPB, agradecemos a la @GobernaciรณnDeBoyacรก, en cabeza de nuestro gobernador, @CarlosAmaya, a todo el equipo de trabajo del Festival Internacional de la Cultura y a nuestra comitiva por haberse sumado a esta gran jornada de orgullo boyacense #ModoFicc.
#AORA24
โฆ@DrDiveshAroraโฉ believes #ESPB is going to stay and letโs not say #RIP to ESP block..
โฆ@AoraIndiaโฉ โฆ@tsmuraliโฉ โฆ@raj_docujjwalโฉ โฆ@loinabhiโฉ
La Empresa Departamental de Servicios Pรบblicos de Boyacรก ๐ง lidera mesas tรฉcnicas de seguimiento al proyecto de la nueva planta de tratamiento de aguas residuales (PTAR) para el municipio de #Aquitania.
#ESPB, #RutaPTAR, #CuidadoAmbiental, #BoyacรกGrande, #ElAguaEsVital ๐
En la Empresa Departamental de Servicios Pรบblicos de Boyacรก (#ESPB) apoyamos la iniciativa #Gallinatรณn #TodosPorPajarito, liderada por nuestro gobernador @CarlosAmayaR. Con gran cariรฑo disfrutaremos esta delicia tรญpica en solidaridad con nuestros hermanos de #Pajarito.
Oral presentation at the @UKPleura Research Conference 2024 on the โRole of Erector Spinae Plane Blocks in Medical Thoracoscopyโ #ESPB #LAVAT @leicschestdoc @mazan1981 @SyedAjmal_Ipoh @Leic_hospital @udit_chaddha @BerlyManju @SjohnstoneSarah @HannaJumma @drhaty @YousufAsfandyar
๐ง ยกReinicio de obra en Aquitania!
La ESPB, bajo el liderazgo del Gerente, ingeniero @RobinsonLarrota , ha reiniciado la obra de Optimizaciรณn y Construcciรณn de la PTAR del casco urbano del municipio de Aquitania, Boyacรก.
#ElAguaEsVital ๐ฆ
#BoyacรกGrande ๐
#ESPB
Discover the efficacy of Ultrasound-Guided ESPB in managing rib fracture pain in adults. Check our latest ED Randomized Control Trial from @Drmanuayyan
#AEM #EM #PainManagement #RibFracture #ESPB
Emerging evidence for Plan A ESPB block
The objective of this COCHRANE SR & MA was to compare the analgesic effects and side effect profile of ESPB against no block, placebo block or any other regional anaesthetic techniques
#ESPB
๐งต
Great video by @KiJinnChin framing the real world role of the #ESPB
https://t.co/O8hUOcsC5h
@amit_pawa @BlockIt_Hot_Pod @ajrmacfarlane @chk29 @BJAJournals @RegionalAnaesUK
Pro-con debate at #ESRAworld2023
@KiJinnChin #ESPB Vs Dr Manoj Karmakar #PVB
๐ฅLA spreads to deeper planes - #DRG
โ๏ธ cutaneous sensory loss โ with meaningful Analgesia
โก fractional dose of LA - differential blockade
โญ #ESPB is good enough - in amateur hands too @IJA_web
Welcome to reading the new perspective authored by Dr. @Steve_Coppens et al.
Stranger things: the erector spinae block, extra sensory perception, or paranormal block by proxy?
#regionalanesthesia #anesthesia #ESPB #painmanagement #acutepain
https://t.co/Kral21bQh4
In press!
Happy to share our most recent publication! #ESPB
https://t.co/BI0HVInj4O
@francisco_alobo @imnitinmanohara
@ESRA_Society @ASRA_Society
For someone like me who works in public sector resource limited set up,in a somewhat remote location, #ESPB due to its simplicity has been a boon for both us and our patients,particularly the huge number of post MRM cases who no longer writhe in agony!
@DebeshBhoi @DrRiteshRoy1
There has recently been a lot of hate for the Erector Spinae Plane Block. Here is our response. The ESP is not the best block but is a very useful #planAblock!
@amit_pawa
@BlockIt_Hot_Pod
@BJAJournals
@RegionalAnaesUK
Free2view๐
https://t.co/BfLc7egAGF
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