Once again, we find that this is not so much a new as an under-appreciated phenomenon. These have in effect been studying spread of fluid along tissue plane/s. ‘Something blue’ – it has been routine for many years in cadaveric anatomic studies in the regional anaesthesia literature to use methylene blue as a marker to track nerve block placement. In regional anaesthesia practice, the dissection occurs solely with a blunt (injected fluid) instrument and is termed ‘hydrodissection’. The key idea which surgeons are emphasising is that of dissecting between structures, and it matters little whether this is with a sharp (e.g., scalpel) or blunt (e.g., finger) instrument. Surgeons also talk about ‘creating’ a plane of dissection or ‘getting into the correct (tissue) plane’. An alternative term for the same idea is the ‘plane of dissection’. ‘Something borrowed’ - The ‘tissue plane’ is a concept borrowed from surgical practice and it forms the foundation of modern surgical dissection technique. The explosion of named techniques using ultrasound guidance in the last several years bears testimony to this development in regional anaesthesia practice. ‘Something new’ – the ability of ultrasound to visualise tissue planes provides a new, or more accurately, a newly appreciated target. These authors would undoubtedly agree though that how we look at anatomy can change, and indeed should change as study and scholarship advances our understanding. This was wittily expressed by Harrop-Griffiths and Denny in relation to the introduction of ultrasound to regional anaesthesia when they suggested that there are ‘no new blocks, just old anatomy’. ‘Something old’ – it may have evolved over geological time, it may distort with congenital, surgical, traumatic or other influences, but fundamentally anatomy has been around for a long time. ‘something old, something new, something borrowed, something blue…’ ![]() The chapter will also review how an understanding of tissue dynamics can further enhance our clinical results by manipulating the characteristics of the tissue plane. The purpose of this chapter is to review the history of the tissue plane in relation to its use in regional anaesthesia, and to see how ultrasound has further advanced the regional anaesthesiologist’s options in this regard. However, the game-changer is that now we can see the tissue plane courtesy of ultrasound. The tissue plane is not new to regional anaesthesia, as it has been the endpoint of ‘loss of resistance’ and ‘pop’ techniques for many decades. The correct term is ‘tissue plane block’, which derives from surgical terminology. In fact, none of these names accurately describes the applied anatomy involved in each named technique, as the acronym is only one part of the anatomic jigsaw puzzle. In recent times, terms such as ‘interfascial plane block’ and ‘fascial plane block’ have become common in describing regional anaesthesia blocks such as transversus abdominis plane (TAP), serratus anterior plane (SAP) and erector spinae plane (ESP).
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