Top Tweets for #ITPBlock

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🏰💉 𝗧𝗛𝗘 𝗧𝗛𝗢𝗥𝗔𝗖𝗜𝗖 𝗖𝗔𝗦𝗧𝗟𝗘! 🎬 𝗙𝗼𝘂𝗿 𝗗𝗲𝗹𝗶𝘃��𝗿𝘆 𝗔𝗴𝗲𝗻𝘁𝘀, 𝗢𝗻𝗲 𝗛𝗶𝗱𝗱𝗲𝗻 𝗖𝗼𝘂𝗿𝘁𝘆𝗮𝗿𝗱 & 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗥𝗼𝘂𝘁𝗲𝘀 𝘁𝗼 𝗔𝗻𝗮𝗹𝗴𝗲𝘀𝗶𝗮! #InterestingRA #RegionalAnaesthesia #ITPBlock #ThoracicAnatomy #Sonoanatomy 💡 𝗜𝗡𝗧𝗘𝗥𝗘𝗦𝗧𝗜𝗡𝗚 𝗥𝗔: #𝟬𝟲 Who said RA is only about nerves and needles? Even local anaesthetic needs the right delivery address! 📦😍 Welcome to the 𝗧𝗛𝗢𝗥𝗔𝗖𝗜𝗖 𝗖𝗔𝗦𝗧𝗟𝗘, where four delivery agents use different routes to approach a hidden courtyard! 🏰 𝗙𝗜𝗥𝗦𝗧, 𝗞𝗡𝗢𝗪 𝗧𝗛𝗘 𝗖𝗔𝗦𝗧𝗟𝗘! 🔹 𝗧𝗣𝗩𝗦: Royal Chamber 👑 🔹 𝗦𝗖𝗧𝗟: Castle Wall 🧱 🔹 𝗜𝗧𝗟: Outer Fence 🚧 🔹 𝗥𝗲𝘁𝗿𝗼-𝗦𝗖𝗧𝗟 𝗦𝗽𝗮𝗰𝗲: Hidden Courtyard 🌳 🔹 𝗖𝗼𝘀𝘁𝗼𝘁𝗿𝗮𝗻𝘀𝘃𝗲𝗿𝘀𝗲 𝗙𝗼𝗿𝗮𝗺𝗲𝗻: Secret Passage 🔑 🔹 𝗣𝗹𝗲𝘂𝗿𝗮: Dangerous Moat 🌊 Now meet our 𝗙��𝗨𝗥 𝗗𝗘𝗟𝗜𝗩𝗘𝗥𝗬 𝗔𝗚𝗘𝗡𝗧𝗦! 🅰️ 𝗠𝗧𝗣 𝗕𝗟𝗢𝗖𝗞 📍 𝗧𝗵𝗲 𝗛𝗮𝗹𝗳𝘄𝗮𝘆 𝗖𝗼𝘂𝗿𝗶𝗲𝗿! Midpoint Transverse Process-to-Pleura (MTP) Block 📦 "Why approach the castle wall when I can stop halfway?" 🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal scan, in-plane caudad → cephalad. 🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Midpoint between the posterior border of the transverse process (TP) and pleura. 💡 𝗦𝗲𝗰𝗿𝗲𝘁: A geometric endpoint, usually posterior to SCTL! 🅱️ 𝗦𝗧𝗜𝗟 𝗕𝗟𝗢𝗖𝗞 🚧 𝗧𝗵𝗲 𝗕𝗲𝘁𝘄𝗲𝗲𝗻-𝘁𝗵𝗲-𝗙𝗲𝗻𝗰𝗲𝘀 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁! Subtransverse Process Interligamentary Plane (STIL) Block 📦 "I'll deliver between the two fences!" 🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal scan, in-plane caudad → cephalad. 🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Anterior to ITL, immediately posterior to the SCTL–cephalad TP junction. 💡 𝗦𝗲𝗰𝗿𝗲𝘁: The interligamentary space is the destination! 🅲 𝗖𝗧𝗙 𝗕𝗟𝗢𝗖𝗞 🔑 𝗧𝗵𝗲 𝗦𝗲𝗰𝗿𝗲𝘁-𝗞𝗲𝘆𝗵𝗼𝗹𝗲 𝗦𝗽𝗲𝗰𝗶𝗮𝗹��𝘀𝘁! Costotransverse Foramen (CTF) Block 📦 "I know exactly where the secret passage begins!" 🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal approach, in-plane caudad → cephalad. 🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Anteroinferior base of the cephalad TP, adjacent to the costotransverse foramen. 💡 𝗦𝗲𝗰𝗿𝗲𝘁: Costotransverse foramen ≠ intervertebral foramen! 🅳 𝗠𝗜𝗖 𝗕𝗟𝗢𝗖𝗞 🚚 𝗧𝗵𝗲 𝗗𝗼𝗼𝗿-𝘁𝗼-𝗗𝗼𝗼𝗿 𝗗𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗔𝗴𝗲𝗻𝘁! Multiple-Injection Costotransverse (MIC) Block 📦 "Why depend on one delivery when I can visit multiple levels?" 🔹 𝗘𝗻𝘁𝗿𝘆: In-plane cephalad → caudad. 🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Cranial aspect of the rib neck associated with the caudad TP, posterior to SCTL. 🔹 𝗠𝗲𝘁𝗵𝗼𝗱: Separate costotransverse injections at multiple thoracic levels. 💡 𝗦𝗲𝗰𝗿𝗲𝘁: Multiple targeted deliveries, not simply a larger single injection! 🌳 𝗕𝗢𝗡𝗨𝗦: 𝗥𝗘𝗧𝗥𝗢-𝗦𝗖𝗧𝗟 𝗕𝗟𝗢𝗖𝗞! 𝗧𝗵𝗲 𝗛𝗶𝗱𝗱𝗲𝗻 𝗖𝗼𝘂𝗿𝘁𝘆𝗮𝗿𝗱 𝗘𝘅𝗽𝗹𝗼𝗿𝗲𝗿! Medial Retro-Superior Costotransverse Ligament Space (Medial Retro-SCTL) Block 📦 "Why guess the delivery address when I can identify the courtyard itself?" 🔹 𝗘𝗻𝘁𝗿𝘆: Transverse/oblique ultrasound approach, in-plane lateral → medial. 🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Medial retro-SCTL space, posterior to SCTL and lateral to the inferior articular process. 💡 𝗦𝗲𝗰𝗿𝗲𝘁: Direct visualisation of the retro-SCTL target. This is a targeted ITP approach, not a fifth original ITPB subtype. 🔬 𝗧𝗛𝗘 𝗥𝗘𝗔𝗟 𝗔𝗡𝗔𝗧𝗢𝗠𝗜𝗖𝗔𝗟 𝗦𝗘𝗖𝗥𝗘𝗧! 🔹 The four classical ITP blocks target the intertransverse tissue complex, generally posterior to SCTL. 🔹 Potential communication with TPVS occurs through costotransverse openings and related tissue pathways. 🔹 Needle-tip position, injection level and tissue characteristics influence spread. 🔹 Paravertebral or epidural spread on imaging does not guarantee equivalent sensory blockade or analgesia. ❤️ 𝗧𝗔𝗞𝗘-𝗛𝗢𝗠𝗘 𝗠𝗘𝗦𝗦𝗔𝗚𝗘! "𝗦𝗮𝗺𝗲 𝗖𝗮𝘀𝘁𝗹𝗲, 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗗𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗔𝗱𝗱𝗿𝗲𝘀𝘀𝗲𝘀!" Different needle tips. Different anatomical pathways. Clinical outcomes must decide whether the delivery succeeded! Because 𝗗𝗬𝗘 ≠ 𝗕𝗟𝗢𝗖𝗞

KartikBSonawane's tweet photo. 🏰💉 𝗧𝗛𝗘 𝗧𝗛𝗢𝗥𝗔𝗖𝗜𝗖 𝗖𝗔𝗦𝗧𝗟𝗘!

🎬 𝗙𝗼𝘂𝗿 𝗗𝗲𝗹𝗶𝘃��𝗿𝘆 𝗔𝗴𝗲𝗻𝘁𝘀, 𝗢𝗻𝗲 𝗛𝗶𝗱𝗱𝗲𝗻 𝗖𝗼𝘂𝗿𝘁𝘆𝗮𝗿𝗱 & 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗥𝗼𝘂𝘁𝗲𝘀 𝘁𝗼 𝗔𝗻𝗮𝗹𝗴𝗲𝘀𝗶𝗮!

#InterestingRA #RegionalAnaesthesia #ITPBlock #ThoracicAnatomy #Sonoanatomy

💡 𝗜𝗡𝗧𝗘𝗥𝗘𝗦𝗧𝗜𝗡𝗚 𝗥𝗔: #𝟬𝟲

Who said RA is only about nerves and needles?
Even local anaesthetic needs the right delivery address! 📦😍

Welcome to the 𝗧𝗛𝗢𝗥𝗔𝗖𝗜𝗖 𝗖𝗔𝗦𝗧𝗟𝗘, where four delivery agents use different routes to approach a hidden courtyard!

🏰 𝗙𝗜𝗥𝗦𝗧, 𝗞𝗡𝗢𝗪 𝗧𝗛𝗘 𝗖𝗔𝗦𝗧𝗟𝗘!

🔹 𝗧𝗣𝗩𝗦: Royal Chamber 👑
🔹 𝗦𝗖𝗧𝗟: Castle Wall 🧱
🔹 𝗜𝗧𝗟: Outer Fence 🚧
🔹 𝗥𝗲𝘁𝗿𝗼-𝗦𝗖𝗧𝗟 𝗦𝗽𝗮𝗰𝗲: Hidden Courtyard 🌳
🔹 𝗖𝗼𝘀𝘁𝗼𝘁𝗿𝗮𝗻𝘀𝘃𝗲𝗿𝘀𝗲 𝗙𝗼𝗿𝗮𝗺𝗲𝗻: Secret Passage 🔑
🔹 𝗣𝗹𝗲𝘂𝗿𝗮: Dangerous Moat 🌊

Now meet our 𝗙��𝗨𝗥 𝗗𝗘𝗟𝗜𝗩𝗘𝗥𝗬 𝗔𝗚𝗘𝗡𝗧𝗦!

🅰️ 𝗠𝗧𝗣 𝗕𝗟𝗢𝗖𝗞 📍
𝗧𝗵𝗲 𝗛𝗮𝗹𝗳𝘄𝗮𝘆 𝗖𝗼𝘂𝗿𝗶𝗲𝗿!

Midpoint Transverse Process-to-Pleura (MTP) Block

📦 "Why approach the castle wall when I can stop halfway?"
🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal scan, in-plane caudad → cephalad.
🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Midpoint between the posterior border of the transverse process (TP) and pleura.
💡 𝗦𝗲𝗰𝗿𝗲𝘁: A geometric endpoint, usually posterior to SCTL!

🅱️ 𝗦𝗧𝗜𝗟 𝗕𝗟𝗢𝗖𝗞 🚧
𝗧𝗵𝗲 𝗕𝗲𝘁𝘄𝗲𝗲𝗻-𝘁𝗵𝗲-𝗙𝗲𝗻𝗰𝗲𝘀 𝗦𝗽𝗲𝗰𝗶𝗮𝗹𝗶𝘀𝘁!

Subtransverse Process Interligamentary Plane (STIL) Block

📦 "I'll deliver between the two fences!"
🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal scan, in-plane caudad → cephalad.
🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Anterior to ITL, immediately posterior to the SCTL–cephalad TP junction.
💡 𝗦𝗲𝗰𝗿𝗲𝘁: The interligamentary space is the destination!

🅲 𝗖𝗧𝗙 𝗕𝗟𝗢𝗖𝗞 🔑
𝗧𝗵𝗲 𝗦𝗲𝗰𝗿𝗲𝘁-𝗞𝗲𝘆𝗵𝗼𝗹𝗲 𝗦𝗽𝗲𝗰𝗶𝗮𝗹��𝘀𝘁!

Costotransverse Foramen (CTF) Block

📦 "I know exactly where the secret passage begins!"
🔹 𝗘𝗻𝘁𝗿𝘆: Parasagittal approach, in-plane caudad → cephalad.
🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Anteroinferior base of the cephalad TP, adjacent to the costotransverse foramen.
💡 𝗦𝗲𝗰𝗿𝗲𝘁: Costotransverse foramen ≠ intervertebral foramen!

🅳 𝗠𝗜𝗖 𝗕𝗟𝗢𝗖𝗞 🚚
𝗧𝗵𝗲 𝗗𝗼𝗼𝗿-𝘁𝗼-𝗗𝗼𝗼𝗿 𝗗𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗔𝗴𝗲𝗻𝘁!

Multiple-Injection Costotransverse (MIC) Block

📦 "Why depend on one delivery when I can visit multiple levels?"
🔹 𝗘𝗻𝘁𝗿𝘆: In-plane cephalad → caudad.
🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Cranial aspect of the rib neck associated with the caudad TP, posterior to SCTL.
🔹 𝗠𝗲𝘁𝗵𝗼𝗱: Separate costotransverse injections at multiple thoracic levels.
💡 𝗦𝗲𝗰𝗿𝗲𝘁: Multiple targeted deliveries, not simply a larger single injection!

🌳 𝗕𝗢𝗡𝗨𝗦: 𝗥𝗘𝗧𝗥𝗢-𝗦𝗖𝗧𝗟 𝗕𝗟𝗢𝗖𝗞!

𝗧𝗵𝗲 𝗛𝗶𝗱𝗱𝗲𝗻 𝗖𝗼𝘂𝗿𝘁𝘆𝗮𝗿𝗱 𝗘𝘅𝗽𝗹𝗼𝗿𝗲𝗿!

Medial Retro-Superior Costotransverse Ligament Space (Medial Retro-SCTL) Block

📦 "Why guess the delivery address when I can identify the courtyard itself?"
🔹 𝗘𝗻𝘁𝗿𝘆: Transverse/oblique ultrasound approach, in-plane lateral → medial.
🔹 𝗡𝗲𝗲𝗱𝗹𝗲 𝘁𝗶𝗽: Medial retro-SCTL space, posterior to SCTL and lateral to the inferior articular process.
💡 𝗦𝗲𝗰𝗿𝗲𝘁: Direct visualisation of the retro-SCTL target. This is a targeted ITP approach, not a fifth original ITPB subtype.

🔬 𝗧𝗛𝗘 𝗥𝗘𝗔𝗟 𝗔𝗡𝗔𝗧𝗢𝗠𝗜𝗖𝗔𝗟 𝗦𝗘𝗖𝗥𝗘𝗧!

🔹 The four classical ITP blocks target the intertransverse tissue complex, generally posterior to SCTL.

🔹 Potential communication with TPVS occurs through costotransverse openings and related tissue pathways.

🔹 Needle-tip position, injection level and tissue characteristics influence spread.

🔹 Paravertebral or epidural spread on imaging does not guarantee equivalent sensory blockade or analgesia.

❤️ 𝗧𝗔𝗞𝗘-𝗛𝗢𝗠𝗘 𝗠𝗘𝗦𝗦𝗔𝗚𝗘!

"𝗦𝗮𝗺𝗲 𝗖𝗮𝘀𝘁𝗹𝗲, 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗗𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗔𝗱𝗱𝗿𝗲𝘀𝘀𝗲𝘀!"

Different needle tips.
Different anatomical pathways.
Clinical outcomes must decide whether the delivery succeeded!

Because 𝗗𝗬𝗘 ≠ 𝗕𝗟𝗢𝗖𝗞

Dr.Kartik Sonawane

@KartikBSonawane

almost 3 years ago

" THORACIC WALL BLOCKS: An Art of Looking Between the Lines" #Thoracicwallblocks #Chestwallblocks #Parasternalblocks #PECSblocks #SAPblocks #PVB #ESPblock #RISSblock #ITPblock My 10 points between 6 LINES: ANTERIOR CHEST WALL BLOCKS: (A) Medial to the Midclavicular line: PMM covers ribs & ICMs in the parasternal region. External ICM becomes the Anterior Intercostal Membrane anteriorly (Posterior Intercostal Membrane is formed by Internal ICM posteriorly). 1. Parasternal blocks: Probe placed sagitally over the parasternal region. LA deposition- Between PMM and ICM for Superficial parasternal block OR between internal ICM and transversus thoracic muscle for Deep parasternal (Transversus Thoracic Plane) block. Coverage- Anterior cutaneous nerve T2-T6. Vascular landmark- Internal mammary A. in TTP block. (B) Between Midclavicular - Anterior axillary lines: Muscles from superficial to deep include PMM, PMnM, and SAM above ribs & ICMs. 2. PEC ZERO (Modified Clavipectoral Fascial Plane) block:* Probe placed vertically between the clavicle (proximally) and 2nd Rib (distally). LA deposition- Above and below PMnM. Vascular landmark- Acromial branch of TAA. 3. PEC 1 (InterPectoral plane) block: Probe over 2nd Rib. LA deposition- Between PMM and PMnM. Vascular landmark- Pectoral branch of TAA. Coverage- LPN & MPN. 4. PEC 2 (Pecto-Serattus Plane) Block: Probe over 3rd Rib. LA depostion (2 injections)- Between PMM-PMnM & PMnM-SAM. Coverage- LPN & MPN, ICNs T2-T6. (C) Between Anterior - Posterior Axillary lines: Muscles include SAM (anterior to midaxillary line). LDM & SAM (posterior to midaxillary line) above the ribs. 5. BRILMA (on 4/5th ribs) and modified BRILMA (on 7/8th ribs): Probe placed at midaxillary. LA depostion- Between SAM and Ribs. Coverage- Lateral cutaneous nerves T2-T7 (BRILMA) and T5-T12 (modified BRILMA). 6. SAP 1 (superficial SAP): Probe between Midaxillary- Posterior axillary lines. LA deposition- Between SAP muscle and LDM at 4/5 th ribs level. Coverage-Intercostobrachial N., T3-T9, LTN, and TDN. SAP 2 (Deep SAP): LA deposition below SAM at 4/5 th ribs level. Vascular landmark- Thoracodoral A above SAM. Coverage- Intercostobrachial N. and T3-T9. POSTERIOR CHEST WALL BLOCKS: (D) Probe kept parasagittal 2.5 cm lateral to the midline: 7. Thoracic PVB: LA deposition above pleura by piercing superior costotransverse ligament. 8. Inter Transverse Process (ITP) Block: LA deposition anterior to C-T ligament in the retro CT space. (E) Probe kept parasagittal 4 cm lateral to the midline: 9. Thoracic ESP Block: LA deposition below ESPM by hitting the tip of the TP. (F) Probe between TP and Scapula: 10. RISS (Rhomboids Intercostal Sub-Serratus plane) Block: LA deposition between RHM-ICM along the Medial border and below SAM at the inferior angle of the Scapula. Coverage- T2-T11 dermatomes.

KartikBSonawane's tweet photo. " THORACIC WALL BLOCKS:
An Art of Looking Between the Lines"

#Thoracicwallblocks
#Chestwallblocks
#Parasternalblocks
#PECSblocks
#SAPblocks #PVB #ESPblock #RISSblock #ITPblock

My 10 points between 6 LINES:

ANTERIOR CHEST WALL BLOCKS:

(A) Medial to the Midclavicular line:

PMM covers ribs & ICMs in the parasternal region. External ICM becomes the Anterior Intercostal Membrane anteriorly (Posterior Intercostal Membrane is formed by Internal ICM posteriorly).

1. Parasternal blocks: Probe placed sagitally over the parasternal region. LA deposition- Between PMM and ICM for Superficial parasternal block OR between internal ICM and transversus thoracic muscle for Deep parasternal (Transversus Thoracic Plane) block. Coverage- Anterior cutaneous nerve T2-T6. Vascular landmark- Internal mammary A. in TTP block.

(B) Between Midclavicular - Anterior axillary lines:

Muscles from superficial to deep include PMM, PMnM, and SAM above ribs & ICMs.

2. PEC ZERO (Modified Clavipectoral Fascial Plane) block:* Probe placed vertically between the clavicle (proximally) and 2nd Rib (distally). LA deposition- Above and below PMnM. Vascular landmark- Acromial branch of TAA.

3. PEC 1 (InterPectoral plane) block: Probe over 2nd Rib. LA deposition- Between PMM and PMnM. Vascular landmark- Pectoral branch of TAA. Coverage- LPN & MPN.

4. PEC 2 (Pecto-Serattus Plane) Block: Probe over 3rd Rib. LA depostion (2 injections)- Between PMM-PMnM & PMnM-SAM. Coverage- LPN & MPN, ICNs T2-T6.

(C) Between Anterior - Posterior Axillary lines:

Muscles include SAM (anterior to midaxillary line). LDM & SAM (posterior to midaxillary line) above the ribs.

5. BRILMA (on 4/5th ribs) and modified BRILMA (on 7/8th ribs): Probe placed at midaxillary. LA depostion- Between SAM and Ribs. Coverage- Lateral cutaneous nerves T2-T7 (BRILMA) and T5-T12 (modified BRILMA).

6. SAP 1 (superficial SAP): Probe between Midaxillary- Posterior axillary lines. LA deposition- Between SAP muscle and LDM at 4/5 th ribs level. Coverage-Intercostobrachial N., T3-T9, LTN, and TDN.

SAP 2 (Deep SAP): LA deposition below SAM at 4/5 th ribs level. Vascular landmark- Thoracodoral A above SAM. Coverage- Intercostobrachial N. and T3-T9.

POSTERIOR CHEST WALL BLOCKS:

(D) Probe kept parasagittal 2.5 cm lateral to the midline:

7. Thoracic PVB: LA deposition above pleura by piercing superior costotransverse ligament.

8. Inter Transverse Process (ITP) Block: LA deposition anterior to C-T ligament in the retro CT space.

(E) Probe kept parasagittal 4 cm lateral to the midline:

9. Thoracic ESP Block: LA deposition below ESPM by hitting the tip of the TP.

(F) Probe between TP and Scapula:

10. RISS (Rhomboids Intercostal Sub-Serratus plane) Block: LA deposition between RHM-ICM along the Medial border and below SAM at the inferior angle of the Scapula. Coverage- T2-T11 dermatomes.

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