Bis Das

🔍 𝐂𝐋𝐀𝐕𝐈𝐏𝐄𝐂𝐓𝐎𝐑𝐀𝐋 𝐅𝐀𝐒𝐂𝐈𝐀𝐋 𝐏𝐋𝐀𝐍𝐄 𝐁𝐋𝐎𝐂𝐊 (𝐂𝐏𝐁): 𝐀𝐧𝐚𝐭𝐨𝐦𝐢𝐜𝐚𝐥 𝐌𝐲𝐭𝐡, 𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐑𝐞𝐚𝐥𝐢𝐭𝐲, 𝐨𝐫 𝐁𝐨𝐭𝐡? 🤔 #RegionalAnesthesia #ClavipectoralFascialPlaneBlock #CPB #ClavicleSurgery #UltrasoundGuidedBlocks #DiaphragmSparingBlocks #OpioidSparingAnalgesia #BilateralClavicleSurgery #FascialPlaneBlocks #CadavericVsClinical #GrayAreasInRA #GrayZonesInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 🧠 Is CPB truly a clavipectoral 𝐅𝐀𝐒𝐂𝐈𝐀𝐋 𝐏𝐋𝐀𝐍𝐄 block? Or is it more accurately a 𝐅𝐈𝐄𝐋𝐃 Block? LET'S EXPLORE, 1️⃣ 📖 𝐄𝐒𝐓𝐀𝐁𝐋𝐈𝐒𝐇𝐄𝐃 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐒𝐓𝐑𝐄𝐍𝐆𝐓𝐇 ✅ Effective surgical anesthesia ✅ Excellent postoperative analgesia ✅ Reduced phrenic nerve palsy risk ✅ Better respiratory safety ✅ Lower motor blockade ✅ Expanding feasibility, including bilateral clavicle surgery 2️⃣ 🦴 𝐂𝐀𝐃𝐀𝐕𝐄𝐑𝐈𝐂 𝐄𝐕𝐈𝐃𝐄𝐍𝐂𝐄 🔬 𝐂𝐨𝐧𝐬𝐢𝐬𝐭𝐞𝐧𝐭𝐥𝐲 𝐃𝐞𝐦𝐨𝐧𝐬𝐭𝐫𝐚𝐭𝐞𝐬 ✅ Reliable supraclavicular nerve staining ✅ Anterosuperior periosteal spread ✅ Superficial muscular plane involvement ⚠️ 𝐂𝐨𝐧𝐬𝐢𝐬𝐭𝐞𝐧𝐭𝐥𝐲 𝐋𝐢𝐦𝐢𝐭𝐞𝐝 ❌ Deep clavipectoral fascia spread ❌ Posteroinferior periosteal coverage ❌ Circumferential clavicular spread 📌 𝐂𝐚𝐝𝐚𝐯𝐞𝐫𝐢𝐜 𝐈𝐧𝐭𝐞𝐫𝐩𝐫𝐞𝐭𝐚𝐭𝐢𝐨𝐧 🔹 CPB may not function through the classic circumferential clavipectoral fascial pathway originally proposed 🔹 CPB appears more superficial and periosteal than purely fascial 3️⃣ ❤️ 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐄𝐕𝐈𝐃𝐄𝐍𝐂𝐄 🩺 𝐑𝐞𝐩𝐞𝐚𝐭𝐞𝐝𝐥𝐲 𝐂𝐨𝐧𝐟𝐢𝐫𝐦𝐬 ✅ Reliable clavicular anesthesia ✅ Opioid-sparing analgesia ✅ Diaphragm preservation ✅ Safer respiratory profile than interscalene techniques ✅ Functional success in live surgical settings 4️⃣ 🌫️ 𝐖𝐇𝐘 𝐓𝐇𝐄 𝐃𝐈𝐒𝐂𝐑𝐄𝐏𝐀𝐍𝐂𝐘 𝐄𝐗𝐈𝐒𝐓𝐒 ⚠️ Cadaveric dye spread maps structure ⚠️ Clinical LA spread defines function 𝐂𝐚𝐝𝐚𝐯𝐞𝐫𝐬 𝐋𝐚𝐜𝐤, ❌ Tissue compliance ❌ Perfusion ❌ Hydrodissection ❌ Fracture hematoma ❌ Dynamic tissue movement 𝐋𝐢𝐯𝐞 𝐓𝐢𝐬𝐬𝐮𝐞 𝐀𝐥𝐥𝐨𝐰𝐬, ✅ Pressure-mediated diffusion ✅ Fascial separation ✅ Peri-fracture redistribution ✅ Dynamic neural blockade 5️⃣ 🧩 𝐁𝐀𝐋𝐀𝐍𝐂𝐄𝐃 𝐈𝐍𝐓𝐄𝐑𝐏𝐑𝐄𝐓𝐀𝐓𝐈𝐎𝐍 📌 CPB likely functions primarily as: 𝐏𝐞𝐫𝐢𝐜𝐥𝐚𝐯𝐢𝐜𝐮𝐥𝐚𝐫–𝐏𝐞𝐫𝐢𝐨𝐬𝐭𝐞𝐚𝐥–𝐒𝐮𝐩𝐫𝐚𝐜𝐥𝐚𝐯𝐢𝐜𝐮𝐥𝐚𝐫 𝐅𝐢𝐞𝐥𝐝 Block 𝐏𝐫𝐢𝐦𝐚𝐫𝐲 𝐌𝐞𝐜𝐡𝐚𝐧𝐢𝐬𝐦𝐬, 🔹 Supraclavicular nerve blockade 🔹 Periosteal infiltration 🔹 Superficial sensory spread 🔹 Dynamic live-tissue diffusion 🔹 Cervical plexus contribution 🏛️ 𝐅𝐈𝐍𝐀𝐋 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 📖 Cadaveric studies challenge the original anatomical theory. 🔹 However, the name may overemphasize clavipectoral fascia involvement ❤️ Clinical studies validate real-world efficacy 🔹 However, Functional analgesia remains consistently reproducible ✅ CPB may not work exactly as originally theorized ✅ Its mechanism may be more field-block than fascial-block ✅ Its clinical efficacy remains increasingly undeniable ✅ Anatomy may refine nomenclature ✅ Functional analgesia defines relevance 🏁 ✅ In RA, Sometimes 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌 is questioned, while 𝐄𝐅𝐅𝐈𝐂𝐀𝐂𝐘 remains unquestionable.

I have changed my practice because of this gem! If you think it’s worthy - please give it a RT & a like!

The ESP: One Block, Two Stops (Dr Palbha Jain)

Ring Block for the Knee (Dr Palbha Jain)

youtube.com/watch?v=JBB5i5… Well I certainly didn't know NVM had two branches - sensory and motor

I’ve just released a video on my channel trying to demystify the Ultrasound Guided Ankle Block. This is a “stripped back” demo, on a #GEHC #VenueGo The aim is to mimic teaching you might get on a workshop Let me know what you think Video available here: youtu.be/Bl0_x-hn3yA?si…

"Local Before Systemic: The True Mechanism Behind ESP Block Analgesia" 🔍 Key Understanding All local anesthetics (LAs), once administered, will eventually enter the systemic circulation. That’s the normal pharmacokinetic fate - not a flaw. But their primary analgesic action is local: at or near the site of injection, before systemic absorption significantly dilutes their concentration. When critics say “ESP block works via systemic absorption,” it implies: 1. The block doesn’t act locally (which is misleading). 2. The systemic LA is somehow responsible for segmental analgesia (which pharmacologically makes little sense). 3. If this were true, IV lignocaine would provide the same result as ESP (and it doesn’t). 🔬 Why Systemic Absorption ≠ Analgesic Mechanism 1. Site-Specific Action Needed for Analgesia Local anesthetics need to be in proximity to nerve membranes where they block voltage-gated sodium channels to inhibit nerve conduction. This is how pain signals are interrupted. Systemically circulating LAs are diluted and not targeted. They cannot block transmission selectively along nociceptive pathways. 2. Non-Selective Sodium Channel Blockade Sodium channels exist throughout the body - in muscles, the heart, brain, gut. Systemic blockade would lead to side effects like: Seizures (CNS toxicity) Arrhythmias (cardiac toxicity) Hypotension (autonomic effects) These are toxicity concerns, not analgesic benefits. 3. All LAs are Absorbed Eventually Saying ESP block doesn’t work because of systemic absorption is like saying femoral nerve block doesn’t work because ropivacaine eventually enters blood. That’s true for every block - it’s not the mechanism, it’s the aftermath. 4. ESP Block Works Because of Local Spread ESP works via interfascial spread to dorsal and ventral rami, possibly even paravertebral space and sympathetic chain (depending on level and volume). The primary action is still local nerve blockade, not systemic analgesia. Therefore to conclude, Criticizing the ESP block by attributing its analgesic effect solely to systemic absorption is pharmacologically unfounded. All local anesthetics, regardless of where they’re injected, are eventually absorbed into the systemic circulation. However, their analgesic efficacy depends on their local action at neural membranes, where they block voltage-gated sodium channels to inhibit nociceptive transmission. Systemic LA concentrations are too low and too non-specific to produce targeted analgesia without toxicity. The ESP block achieves its effect through local spread to segmental nerves, not through systemic distribution. Therefore, dismissing ESP on these grounds reflects a misunderstanding of both basic pharmacology and regional anesthetic principles.

@PradeepSamtani @Siva6faces @ASRA_Society @ASALifeline @AbaPhysicians @KalagaraHari @EMARIANOMD @Ropivacaine @Shankaru72 @AoraIndia @RenukaGeorge @Nadia_Hdz_MD @SreeHPraveenKO1 @jeffgadsden @saraamaralMD @BlockIt_Hot_Pod It was something I thought I came up with myself (as others were doing on the other side of the Atlantic it seems!) It looks like a medal Podium! 1st place = 1st rib 2nd place = pleura anterior to rib 3rd place = pleura posterior to rib

@amit_pawa speaking on ESP #ASURA25 #POCUS @BlockIt_Hot_Pod @RegionalAnaesUK @ESRA_Society @jeffgadsden @KiJinnChin

Femoral Triangle Block (Michael Ratnasingham, GSTT)

TAP blocks DO work for the right incision (ie pfannensteil). 3 problems with TAP: 1) Using it for the wrong indication. They don’t get above the umbilicus, so why are people using them for upper abdominal surgery? That’s a mismatch 2) Some are still doing “subcostal TAP” and hoping it works for upper quadrants. Sadly, you’re really only doing a rectus sheath block as this targets the anterior cutaneous branches, leaving the lateral parts of the upper abdomen unblocked. Use an external oblique intercostal instead is my advice. Easier, and it works. 3) Finally, there are technical aspects to performing TAP block that are nuanced. You can’t just dump 20 ml in one spot and walk away. You need to continually advance the needle to ensure adequate spread. TAP for c-section is 😚👌 BUT you have to do it right. If you’re looking to understand this more check this video out: Ultrasound Guided Transversus Abdominis Plane (TAP) Block youtu.be/OqedcP9OPvc

An interesting anatomical variant - double axillary artieries. Inspired by a post from @DrRobbieErskine! youtu.be/Hwxw1tYfhGs

In case you may be interested… #RegionalAnaesthesia #RegionalAnesthesia Counting Ribs With Ultrasound youtu.be/JqbS-eqxEss

A timely reminder that there are spaces available at this @RegionalAnaesUK Approved Course - the Burton EDRA Part 2 course 🇪🇺 Prepare for the @ESRA_Society-DRA 🗓️ Friday 29th August 2025 📍 Burton UK

The radial trinity block of the upper extremity: combined block of the radial, median, and lateral cutaneous nerves of the forearm for radial fracture. New commentary by Sethuraman et al #anaesthesia #regional bjanaesthesia.org/article/S0007-…

Excellent news @RegionalAnaesUK Excellent Faculty Exam like conditions practice I totally recommend before attending your part 2 EDRA exam 👌👍 @ESRA_Society

𝗖𝗼𝘂𝗿𝘀𝗲𝘀 𝗨𝗽𝗱𝗮𝘁𝗲! The team from Burton have created more spaces for this course Burton EDRA Part 2 Prep Course ✅ 𝟭𝟱% 𝗗𝗶𝘀𝗰𝗼𝘂𝗻𝘁 𝗳𝗼𝗿 𝗥𝗔-𝗨𝗞 𝗠𝗲𝗺𝗯𝗲𝗿𝘀! ❤️ 𝗟𝗶𝗸𝗲 ↗️ 𝗙𝗼𝗹𝗹𝗼𝘄 💻 𝗝𝗼𝗶𝗻: ra-uk.org

@RegionalAnaesUK It’s hard to run successful courses so well done to @Bis_Das1 and his team for opening up extra spaces. Take advantage of the RA-UK discount and grab a place before it’s full up.

𝗥𝗔-𝗨𝗞 𝗔𝗽𝗽𝗿𝗼𝘃𝗲𝗱 𝗖𝗼𝘂𝗿𝘀𝗲 Burton EDRA Part 2 Prep Course 🗓️ Fri 30th Aug 2024 📍 Medical Education Centre, Burton, DE13 0RB 🤩 Distinguished faculty / live scanning / exam tips ✉️ t.ly/EQnC7 ✅ 𝟭𝟱% 𝗗𝗶𝘀𝗰𝗼𝘂𝗻𝘁 𝗳𝗼𝗿 𝗥𝗔-𝗨𝗞 𝗠𝗲𝗺𝗯𝗲𝗿𝘀

@docmadhu82 Poor sumit kumar lost it in the final over. Hope he will learn with more exposure

Curran & Livingstone finishing off a match ! I used to dream of days like this 😅 #IPL2024