Long-lasting pain relief with interfascial plane blocks: key role of opening interfascial adhesions

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Korean J Anesthesiol. 2021;74(6):559-560
Publication date (electronic) : 2020 December 29
doi : https://doi.org/10.4097/kja.20650
1Department of Anesthesiology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
2Department of Algology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
3Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
4Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, Erzurum, Turkey
Corresponding author: Bahadir Ciftci, M.D. Department of Anesthesiology, Istanbul Medipol University Faculty of Medicine, Istanbul 34040, Turkey Tel: +90-532 503 44 28 Fax: +90-2124607070 Email: bciftci@medipol.edu.tr
Received 2020 December 8; Accepted 2020 December 27.

We read with great interest the correspondence by Piraccini and Byrne [1] in response to our report of a patient with myofascial pain syndrome (MPS), who underwent rhomboid intercostal block (RIB) at our clinic [2].

We thank the authors for their valuable comments and opinions. Their article might show a new way for both diagnosis and treatment of MPS due to fascial adhesion. We would like to share the details of long-term pain relief in our patient as additional information.

RIB is a novel interfascial block that has been used to treat MPS in recent times [2,3]. MPS is a chronic condition, and few cases might be refractory. MPS can be primary or secondary [1,2]. In secondary cases, such as in our patient, interfascial plane blocks might be a good alternative for treatment. However, it is not clear whether they provide short-term or long-term relief. To the best of our knowledge, previous case reports in the literature have described short-term pain relief on using fascial plane block for MPS [35]. Piraccini and Maitan [3] performed RIB in a female patient who had fascial adhesions and reported successful results; however, the long-term outcomes are unknown. Similarly, Piraccini et al. [4] performed an erector spinae plane block (ESPB) for MPS, but the authors emphasize that ESPB provides short-term relief and that fascial plane blocks should be combined with physical therapy.

In our case, we performed RIB using 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone [2]. The patient was followed up for four weeks. For the first two weeks, we prescribed 25 mg oral dexketoprofen and 8 mg of thiocolchicoside. After four weeks of observation, the patient underwent follow-up once a month. He is still under follow-up. He had no recurrence of MPS in the last 6 months, required no analgesic drugs, and did not undergo physical therapy. He continues his work and daily activities. Our patient might have had fascial adhesions but experienced long-term relief with fascial hydro-dissection and bupivacaine with 8 mg of dexamethasone. Chronic pain is complicated, and interfascial adhesions might play a key role in this complex process. We aimed to treat several steps associated with the pain mechanism by using multimodal analgesia management with hydro-dissection.

The use of fascial plane blocks for MPS is a novel technique. There is a lack of information about long-term results in the literature. Further studies and larger case series are necessary to validate the results.




Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Mürsel Ekinci (Conceptualization; Investigation; Methodology; Writing – original draft)

Bahadir Ciftci (Conceptualization; Investigation; Methodology; Writing – original draft)

Haci Ahmet Alici (Investigation; Methodology; Writing – review & editing)

Ali Ahiskalioglu (Conceptualization; Methodology; Writing – review & editing)


1. Piraccini E, Byrne H. The efficacy of fascial plane blocks for myofascial pain syndrome: do they achieve long-term results? Korean J Anesthesiol 2020;73:566–7.
2. Ekinci M, Ciftci B, Alici HA, Ahiskalioglu A. Ultrasound-guided rhomboid intercostal block effectively manages myofascial pain. Korean J Anesthesiol 2020;73:564–5.
3. Piraccini E, Maitan S. Ultrasound guided rhomboid plane hydrodissection for fascial adhesion. J Clin Anesth 2020;59:13.
4. Piraccini E, Calli M, Taddei S, Byrne H, Rocchi M, Maitan S. Erector spinae plane block for myofascial pain syndrome: only a short-term relief? Minerva Anestesiol 2020;86:888–90.
5. Tulgar S, Thomas DT, Suslu H. Ultrasound guided erector spinae plane block relieves lower cervical and interscapular myofascial pain, a new indication. J Clin Anesth 2019;53:74.

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