Top Tweets for #PainAtTheCore

about 1 year ago

🔥🫁 "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."

$KartikBSonawane's tweet photo. 🔥🫁 "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."$

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