Interfascial Block by Ultrasound-Guided Puncture for the Treatment of Myofascial Pain Of

Interfascial block by ultrasound-guided puncture for the treatment of myofascial pain of the trapezius muscle.

Tomás Domingo-Rufes1 MD, Maribel Miguel-Pérez2 MD PhD, Victor Mayoral1 MD, Juan Blasi3 PhD, Antonio Sabaté1 MD PhD.

1 Consultant anaesthesiology. Department of Anaesthesia and Pain Therapy Hospital Universitari de Bellvitge. C / Feixa Larga s / n 08907 L'Hospitalet de Llobregat (Barcelona). Spain. 2 Unit of Human Anatomy and Embryology. 3Unity of Histology. Department of Experimental Pathology and Therapeutic. Faculty of Medicine (HSC.Bellvitge). University of Barcelona. Spain.

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BACKGROUND Interfascial space between the trapezius and levator scapulae, supraspinatus and rhomboid major containing nerve structures provide sensory and motor innervation to the muscles themselves and surrounding tissues. The main goal of treatment of myofascial pain is muscle relaxation, and then performing stretching exercises rehabilitation techniques. In our unit we have applied the interfascial block technique by ultrasound-guided puncture at 90 patients with myofascial pain of trapezius muscle.

METHODS We studied 90 patients (63 women and 28 men) with myofascial pain in the trapezius muscle. Trigger Points were present in the all patients. Mean age 55 years (27 - 86). 52 patients had unilateral pain and 38 unilateral. Body Mass Index: 25 (18 - 35). Patients were seen consecutively in our unit of pain over a period of 18 months and had myofascial pain over three months. All patients had received drug treatment no spontaneous improvement and agreed to receive treatment after signing informed consent. Pain was assessed by VAS (0: no pain, 10 worst pain) before and after the procedure. The puncture was performed with a 22G Quincke 0.72 x 90 mm of Vygon ® (Écouen, France) and an ultrasound SonoSite M-Turbo ™ (Bothell, WA, USA) equipped with a linear probe (13 - 6 MHz). VAS means before performing the technique: 5.4 (4 - 7). Depending on the location of trigger points injection was made between the fascia of the trapezius and levator scapula, trapezius and supraspinatus and trapezius and rhomboid major. After usual measures of sterility were introduced the needle in plane and was located by hydrodissection the interfascial space.

We Injected 6 ml of bupivacain 0,125% without vasoconstrictor and 4 mg of dexamethasone. It instructed all patients to undertake muscle rehabilitation techniques.

RESULTS 84 patients presented after the technique VAS medium: 1.8 and 6 patients without improvement. In 12 patients the technique was repeated at 3 months and 3 for a third time at 6 months. All patients were discharged on an outpatient basis after performing the technique. There were no complications due to technical or signs of local anesthetic toxicity.

CONCLUSION We believe it is essential to the use of ultrasound-guided needle localization of space interfascial success. The patients rated the technique as comfortable and painless. The presence of nervous structures in the fascia allows us to understand the relaxing and analgesic technique on the affected muscle. It is essential to carry out rehabilitation exercises to maintain and improve long-term results.