Anatomy and Ultrasound: General Considerations

In recent years, the advent and wide use of Enhanced Recovery After Surgery (ERAS) programs have led to the development of minimally invasive surgical techniques, in order to reduce postoperative pain compared to open techniques. Contextually, the need was felt to introduce in clinical practice analgesic strategies that combine effectiveness and safety profile. Despite their proven effectiveness, standard analgesic techniques such as thoracic epidural and paravertebral block may be associated with potential side effects and complications. The advent of ultrasound and a better understanding of the human fascial system led to the introduction of fascial plane blocks (FPBs), which currently represent the minimally invasive evolution of regional anesthesia for acute and chronic pain management. Despite the popularity of FPBs, their mechanisms of action and clinical results remain controversial. A recent experts’ opinion has highlighted that the variability of FPB outcome may depend on various factors that may be classified into operator related, patient related, and drug related. In the last few years, several sonoanatomical signs have been described as markers of correct execution of FPBs, in order to optimize the success of these techniques. Among these signs, we should remember the double V and dynamic double V signs, which now represent cornerstones for every anesthesiologist who performs FPBs. Nowadays, we should always check the presence of sonoanatomical signs keeping in mind factors that may influence FPB’s success. Only by respecting these golden rules will we be able to best integrate these techniques into contemporary perioperative analgesia protocols, ultimately improving the outcome of our patients.