EAJAIC
Eurasian Journal of Anesthesiology and Intensive Care

The Eurasian Journal of Anesthesiology and Intensive Care (EAJAIC) is an independent-unbiased, peer-reviewed, "double-blind", and open-access journal of current national and international issues and reviews for original clinical and experimental research, interesting case reports, differential diagnoses, editorial opinions, letters to the editor, and educational papers in anesthesiology, algology, and intensive care medicine.

ISSN: Active
eISSN: 3023-6738
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Review
Combinations of fascial plane block techniques: a new era and broad horizons in anesthesia and analgesia management
Abstract
The development of ultrasound-guided fascial plane blocks (FPBs) has revolutionized regional anesthesia, extending their use beyond postoperative analgesia toward surgical anesthesia, particularly in high-risk patients. Combining FPBs to target multiple anatomical planes has emerged as a promising approach to achieve broader sensory coverage and improve analgesic efficacy. This review explores clinically relevant combinations of fascial plane block techniques and their applications in various surgical settings. FPB combinations represent a significant advancement in regional anesthesia by optimizing analgesic coverage, reducing reliance on general or neuraxial anesthesia, and improving perioperative outcomes. Despite their growing use, limitations include variability in local anesthetic spread, requirement for high volumes, and incomplete sensory blockade compared with traditional regional techniques. Future prospective studies are needed to confirm their efficacy and define standardized protocols. Nevertheless, FPB combinations constitute a versatile and evolving component of multimodal anesthesia practice.

Keywords : Fascial plane block, block combination, regional anesthesia, analgesia, multimodal analgesia, ultrasound-guided block

Download Article


1. Tulgar S, Ahıskalıoğlu A, Kilicaslan A, et al. Fascial plane blocks as the main anesthetic method: A narrative review.Saudi J Anaesth. 2025;19(2):198-208. doi:10.4103/sja.sja_844_24
2. Chin KJ, Versyck B, Pawa A. Ultrasound-guided fascial plane blocks of the chest wall: a state-of-the-art review.Anaesthesia. 2021;1:110-126. doi:10.1111/anae.15276
3. Chin KJ. Thoracic wall blocks: From paravertebral to retrolaminar to serratus to erector spinae and back again - A review of evidence.Best Pract Res Clin Anaesthesiol. 2019;33(1):67-77. doi:10.1016/j.bpa.2019.02.003
4. Coppens S, Eochagain AN, Hoogma DF, et al. Stranger things: the erector spinae block, extra sensory perception, or paranormal block by proxy?. APS. 2023;1(2):12. doi:10.1007/s44254-023-00007-5
5. Chin KJ, Pawa A, Forero M, Adhikary S. ultrasound-guided fascial plane blocks of the thorax: pectoral i and ii, serratus anterior plane, and erector spinae plane blocks.Adv Anesth. 2019;37:187-205. doi:10.1016/j.aan.2019.08.007
6. Ertas G, Cakmak HS, Ocak S, Yılmaz M, Ozdemir DB, Tulgar S. Is the combination of interfascial plane blocks sufficient for awake breast cancer surgery? An observational, prospective, proof-of-concept study.BMC Anesthesiol. 2024;24(1):337. doi:10.1186/s12871-024-02725-0
7. Bagaphou TC, Santonastaso DP, Cerotto V, et al. Combined PECs II block with parasternal block for awake radical mastectomy.Minerva Anestesiol. 2022;88(12):1078-1079. doi:10.23736/S0375-9393.22.16785-4
8. Tulgar S, Kiziltunç B, Thomas DT, Manukyan MN, Ozer Z. The combination of modified pectoral nerves block and rhomboid intercostal block provides surgical anesthesia in breast surgery.J Clin Anesth. 2019;58:44. doi:10.1016/j.jclinane.2019.04.040
9. Zengin M, Baldemir R, Ülger G, Sazak H, Alagöz A. Comparison of deep and combined serratus anterior plane block after video-assisted thoracoscopic surgery; a prospective randomized trial.J Health Sci Med. 2023;6(1):18-24. doi:10.32322/jhsm.1185437
10. Zengin M, Sazak H, Baldemir R, Ulger G, Alagoz A. The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study.J Cardiothorac Vasc Anesth. 2022;36(8):2991-2999. doi:10.1053/j.jvca.2022.01.048
11. Ülger G, Zengin M, Küçük O, et al. Comparison of combined deep and superficial serratus anterior block with thoracic paravertebral block for postoperative pain in patients undergoing video-assisted thoracoscopic surgery. Turk J Med Sci. 2024;54(5):1021-1032. doi:10.55730/1300-0144.5881
12. Ozguner Y, Yazar CO, Aydın F, et al. Comparison of the analgesic efficacy of combined superficial and deep serratus anterior plane block versus pectoserratus plane block following modified radical mastectomy surgery.BMC Anesthesiol. 2025;25(1):358. doi:10.1186/s12871-025-03213-9
13. Selvi O, Tulgar S, Senturk O, et al. Is a Combination of the serratus intercostal plane block and rectus sheath block superior to the bilateral oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy? Eurasian J Med. 2020;52(1):34-37. doi:10.5152/eurasianjmed.2019.19048
14. Ohgoshi Y, Kawagoe I, Ando A, Ikegami M, Hanai S, Ichimura K. Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers. Un nouveau bloc du plan musculaire oblique externe pour le bloc de la paroi abdominale latérale : une étude pilote auprès de volontaires.Can J Anaesth. 2022;69(10):1203-1210. doi:10.1007/s12630-022-02310-4
15. Tulgar S, Yılmazer MS, Kızıltunc B, Thomas DT, Manukyan MN. The combination of ultrasound guided transversalis fascia plane block and transversus abdominis plane block: An alternative method for anesthesia in inguinal herniorrhaphy.J Clin Anesth. 2019;56:129-130. doi:10.1016/j.jclinane.2019.02.008
16. Dost B, De Cassai A, Karapinar YE, et al. Efficacy of superficial versus deep parasternal intercostal plane blocks in cardiac surgery: a systematic review and meta-analysis.J Cardiothorac Vasc Anesth. 2025;39(10):2837-2847. doi:10.1053/j.jvca.2025.05.053
17. Zengin, EN, Salman, N, Analgesic effects of thoracic fascial plane blocks in postoperative pain management following cardiac surgery with sternotomy: a retrospective study.Anatolian Curr Med J.2023;6(2):127-132. doi: 10.38053/acmj.1421102
18. Tulgar S, Ciftci B, Ahiskalioglu A, et al. Recto-intercostal fascial plane block: Another novel fascial plane block.J Clin Anesth. 2023;89:111163. doi:10.1016/j.jclinane.2023.111163
19. Ciftci B, Omur B, Alver S, Akin AN, Yildiz Y, Tulgar S. The medipol combination: novel rectointercostal fascial plane block and pectointercostal fascial plane block for postoperative analgesia management after cardiac surgery: a report of 15 cases.A A Pract. 2024;18(6):e01794. doi:10.1213/XAA.0000000000001794
20. Zengin EN, Yiğit H, Çobas M, Salman N, Aslı Demir Z. The analgesic effects of combined bilateral parasternal block and serratus anterior plane block for coronary artery bypass grafting surgery.BMC Anesthesiol. 2024;24(1):274. doi:10.1186/s12871-024-02659-7
21. Kukreja P, Schuster B, Northern T, Sipe S, Naranje S, Kalagara H. Pericapsular Nerve Group (PENG) block in combination with the quadratus lumborum block analgesia for revision total hip arthroplasty: a retrospective case series.Cureus. 2020;12(12):e12233. doi:10.7759/cureus.12233
22. Tulgar S, Ermis MN, Ozer Z. Combination of lumbar erector spinae plane block and transmuscular quadratus lumborum block for surgical anaesthesia in hemiarthroplasty for femoral neck fracture.Indian J Anaesth. 2018;62(10):802-805. doi:10.4103/ija.IJA_230_18
23. Reysner T, Wieczorowska-Tobis K, Kowalski G, Lapaj L, Daroszewski P, Reysner M. iPACK block with adductor canal block vs. lumbar erector spinae plane block (L-ESPB) in total knee arthroplasty: a randomized, double-blinded, controlled trial.Anaesthesiol Intensive Ther. 2025;57(1):195-204. doi:10.5114/ait/208016
24. Kilicaslan A, Tulgar S, Ahiskalioglu A, et al. Ultrasound-guided biceps femoris short head block: a novel regional anesthesia technique for the posterolateral knee.Pain Med. 2025;26(11):726-732. doi:10.1093/pm/pnaf068
Article available in :
Volume 2, Issue 4, 2025
Page : 134-137
https://doi.org/10.51271/EAJAIC-0044
Article Information
Received : 25 Eki 2025
Accepted : 11 Kas 2025
Published : 13 Kas 2025
Corresponding Author :

Musa Zengin: Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkiye

[email protected]
Citation : Çiftçi B, Zengin M. Combinations of fascial plane block techniques: a new era and broad horizons in anesthesia and analgesia management. Eur J Anesthesiol Intens Care. 2025;2(4):134-137.

Read: 660
Download : 605
Cited: 0
_Footer