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Interfascial Plane Blocks: Back to Basics

Elsharkawy, Hesham, MD, MBA, MSc*; Pawa, Amit, MBBS(Hons), FRCA†‡; Mariano, Edward, R., MD, MAS§

Regional Anesthesia and Pain Medicine: May 2018 - Volume 43 - Issue 4 - p 341–346
doi: 10.1097/AAP.0000000000000750

Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.

From the *Staff Departments of General Anesthesia and Pain Management, Outcomes Research, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH; †Guy's & St Thomas' NHS Foundation Trust and ‡Department of Anaesthesia, St Thomas' Hospital, London, United Kingdom; and §Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and VA Palo Alto Health Care System, Palo Alto, CA.

Accepted for publication October 29, 2017.

Address correspondence to: Hesham Elsharkawy, MD, MBA, MSc, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave, E-31 Cleveland, OH 44195 (e-mail:

No external funding and no competing interests were declared.

H.E. has received unrestricted educational funding from PAJUNK (Norcross, GA) and is consultant for PACIRA (Troy Hills, NJ). A.P. has received honoraria from GE Healthcare, Pittsburgh, PA, for teaching. E.R.M. has received unrestricted educational program funding from Halyard Health (Alpharetta, GA). These companies had no input into any aspect of the present project design or manuscript preparation.

Permission to use images was obtained from the Cleveland Clinic Department of Art Photography.

Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.