The fascial plane concept

The muscular fascias surrounding peripheral nerves create an enclosed space. Their elasticity determines the size and shape of the space thus affecting the distribution of local anaesthetics. We suggest that application of a local anaesthetic into an "optimal" space outlined by the fascial planes, in particular under ultrasound guidance, largely determines the quality of the peripheral nerve block. In contrast, effort to apply local anaesthetics as close as possible to the peripheral nerve increases the risk of peripheral nerve damage. On the basis of histological studies of the tissues surrounding the nerves, CT and MRI studies performed on the author and other healthy volunteers, and clinical studies using ultrasound imaging we propose that the "fascial plane concept" enhances the safety of peripheral nerve blocks. We speculate that using the "fascial plane concept", nerve injury and neurological damage as a consequence of peripheral nerve blockade will have lower incidence thus enhancing the safety of regional anaesthesia.

Keywords: regional anaesthesia; muscular fascias; ultrasound; peripheral nerve block