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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Fascial blocks in the COVID-19 era: An alternative to consider
Journal Information
Vol. 69. Issue 2.
Pages 122 (February 2022)
Vol. 69. Issue 2.
Pages 122 (February 2022)
Letter to the Director
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Fascial blocks in the COVID-19 era: An alternative to consider
Bloqueos fasciales en la era COVID-19: una alternativa a considerar
M.T. Fernández Martína,
Corresponding author

Corresponding author.
, S. López Álvarezb
a Servicio de Anestesiología, Hospital Universitario Río Hortega, Valladolid, Spain
b Servicio de Anestesiología, Hospital Abente y Lago, A Coruña, Spain
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To the Editor,

We read with interest the clinical case presented by Días et al.1, in which the authors describe the use of a combination of fascial blocks in breast surgery: PEC II block, pecto-intercostal fascial block, and supraclavicular nerve branch block. Although they present this combination of blocks as a new technique in this type of surgery, they acknowledge that analgesia of the anterior chest wall, at the medial level, was insufficient.

In our experience, based on the innervation of the chest wall, performing a serratus intercostal block in the midaxillary line at the level of the fourth rib (BRILMA) is an opioid-saving technique that provides adequate analgesia for this type of surgery2 and reduces the risk of chronic pain associated with this procedure3. We, therefore, believe that administering 2 effective blockades (PEC and BRILMA)4 would overcome the analgesia deficit encountered with the authors’ technique.

We agree that the risk of infection should be minimised in the COVID-19 era by avoiding airway manipulation, particularly in patients who have tested positive or have suspected COVID without a PCR confirmation test. Our obligation is to provide good quality care with minimal risks, and we therefore agree with Días et al., that in the COVID era and indeed at any other time, fascial blocks are a good analgesic option to consider not only at the level of the chest wall, where combined techniques have been proven effective, but also in surgery of the upper abdominal wall. The new fascial blocks have been presented as an effective option in these procedures5, and can sometime replace general anaesthesia.

This is why we believe fascial blocks, which preclude the need for airway management in many different surgeries, should always be included in anaesthesia and analgesia strategies.

R. Días, Â.B. Mendes, N. Lages, H. Machado.
Ultrasound-guided fascial plane blocks as unique anesthetic technique for total mastectomy in a COVID-19 era: a case report.
Rev Esp Anestesiol Reanim, (2021),
O. Varela, A. Melone, R. López-Menchaca, R. Sevilla, D. Callejo, S. López-Álvarez, et al.
Radiological study to evaluate the spreading of two volumes (10 vs 20 ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model.
Rev Esp Anestesiol Reanim, 65 (2018), pp. 441-446
M.A. Pérez Herrero, S. López Alvarez, A. Fadrique Fuentes, F. Manzano Lorefice, C. Bartolomé Bartolomé, J. González de Zárate.
Calidad de la recuperación posquirúrgica tras cirugía de mama. Anestesia general combinada con bloqueo paravertebral versus bloqueo del espacio serrato-intercostal.
Rev Esp Anestesiol Reanim, 63 (2016), pp. 564-571
M.T. Fernández Martín, S. López Álvarez.
BRILMA and PEC blocks: simpler and more adequate options in radical breast surgery.
Rev Esp Anestesiol Reanim, 65 (2018), pp. 478-479
M.T. Fernández, S. López, J.A. Aguirre, J. Andrés, E. Ortigosa.
Serratus intercostal interfascial plane block in supraumbilical surgery: a prospective randomized comparison.
Minerva Anestesiol, 87 (2021), pp. 165-173

Please cite this article as: Fernández Martín MT, López Álvarez S. Bloqueos fasciales en la era COVID-19: una alternativa a considerar. Rev Esp Anestesiol Reanim. 2022;69:122.

Copyright © 2021. Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor
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