NYSORA Nerve Block Manual

Pain after median sternotomy remains one of the most challenging aspects of cardiac anesthesia and recovery. Despite advances in surgical technique and multimodal analgesia, many patients experience moderate to severe discomfort in the early postoperative period. This pain is not merely distressing—it directly interferes with deep breathing, coughing, and mobilization, all essential components of enhanced recovery pathways. When pain limits these functions, pulmonary complications such as atelectasis and pneumonia become more likely, leading to longer mechanical ventilation and ICU stays. Regional anesthesia has become an increasingly important tool in addressing this issue, providing effective, targeted analgesia without the hemodynamic risks associated with neuraxial techniques. The ultrasound-guided parasternal (pecto-intercostal plane) block is one of the most widely adopted options for median sternotomy. By anesthetizing the anterior cutaneous branches of the intercostal nerves (T2–T6), it provides substantial relief from sternal pain and reduces opioid consumption. However, the parasternal block does not consistently cover the lower sternum and epigastric region—precisely where mediastinal and pleural drains emerge. Pain at these drain exit sites can persist even when the sternum itself is well controlled, compromising respiratory exercises and delaying extubation. The rectus sheath block (RSB), traditionally used for midline abdominal incisions, targets the anterior cutaneous branches of T6–T9 and may therefore complement the parasternal block by extending coverage to this critical epigastric zone. This study set out to determine whether combining the rectus sheath block with the parasternal block could improve pain control and respiratory recovery after cardiac surgery via median sternotomy. Study objective and methods The primary objective of the study was to determine whether parasternal and rectus sheath blocks improve pain at rest at extubation compared to parasternal and epigastric infiltration.  Design: Single-centre, single-blinded, randomized controlled superiority trial. Setting: University Hospital, Italy. Population: 58 adult patients (ASA I–IV) undergoing elective cardiac surgery via […]

Hip fractures are among the most painful orthopedic injuries, particularly during movement or even minor positional changes before surgery. This intense pain not only compromises patient comfort but also activates the sympathetic nervous system, impacts hemodynamic stability, and complicates positioning for spinal anesthesia. Effective preoperative analgesia is therefore critical—not only to improve patient experience but also to optimize surgical conditions and reduce reliance on systemic opioids. Peripheral nerve blocks (PNBs) have become an integral part of multimodal pain management strategies for hip fractures. They lower pain scores, reduce opioid consumption, and are especially beneficial in older patients, who face heightened risks of opioid-related side effects. Current guidelines recommend fascia iliaca compartment block (FICB), with the supra-inguinal approach (SIFICB) offering broader sensory coverage than the conventional infra-inguinal technique. The SIFICB covers the femoral nerve and lateral femoral cutaneous nerve (LFCN), with spread to the obturator nerve in some cases. This broad coverage makes SIFICB effective for both hip and lateral thigh pain. More recently, the pericapsular nerve group (PENG) block has been introduced as a targeted option for hip analgesia. By blocking articular branches of the femoral, obturator, and accessory obturator nerves—responsible for innervating the anterior hip capsule—PENG aims to deliver potent pain relief while sparing quadriceps strength. This motor-sparing feature has led some clinicians to consider PENG superior to FICB, particularly in frail or elderly patients requiring early mobilization. This randomized controlled trial directly compared the efficacy of PENG and SIFICB for managing dynamic pain in patients with hip fractures, providing substantial new evidence for clinical decision-making. Study objective and methods The primary objective of this study was to evaluate whether the PENG block provides greater reduction in dynamic pain (pain during passive hip flexion) compared to the SIFICB in patients with hip fractures.  Study design Type: Prospective, single-center, randomized […]