Approach and Troubleshooting to Posterior Truncal Blocks

The regional anaesthesia practice using landmark technique has observed a change to peripheral nerve stimulator technique and now has been steered to ultrasound-guided regional nerve blocks. With the advent of fascial plane blocks the role of landmark and peripheral nerve stimulator is no longer considered precise. The modern-day anaesthesiologist has to master the regional anaesthesia techniques for nerve and fascial plane blocks. For this, a detailed knowledge of anatomy and stereoscopic skills are required. The regional anaesthesia performed on trunk is called truncal blocks. The present chapter will cover the relevant anatomy, sonoanatomy, commonly performed techniques of different posterior truncal blocks and any required troubleshooting. The posterior truncal blocks which are included in this chapter are Paravertebral block (PVB), Erector spinae plane block (ESPB), Retrolaminar block (RLB), Intercostal nerve block, Quadratus lumborum (QL) block, and thoracolumbar interfacial plane (TLIP) block. The growing importance of posterior truncal blocks can be understood with the fact that it cover both somatic and visceral pain as it is close to the spinal cord and also do not have the risk associated as reported in neuraxial procedures.