Clarification on Interfascial Plane Blocks for Cardiac Surgery
Bibliographic record
Abstract
To the Editor In their recent publication, Kelava et al1 provide a comprehensive review of the various ultrasound-guided fascial plane chest wall blocks used in cardiac surgery. In doing so, they outlined the sonoanatomy, block techniques, clinical applications, and complications. The supplemental digital content is particularly interesting, with high-quality illustrations and detailed description of the chest wall anatomy that provide an enhanced understanding of these blocks. However, their discussion of the erector spinae plane (ESP) block contains several areas that warrant questioning. For example, the authors state that “ventral rami blockade is essential for analgesia of the chest wall midline and sternal regions, while the dorsal rami blockade addresses the midclavicle and lateral regions of the chest.”1 Sensory innervation of the anterior (midclavicular line) and lateral chest wall is provided by the anterior and lateral intercostal cutaneous branches of the intercostal nerves, which derive from the “ventral rami” of the thoracic spinal nerves, not the “dorsal rami.” Therefore, ventral rami blockade is essential for analgesia of both the sternal region and midclavicular and lateral regions of the chest wall. We also disagree with the statement that “there have been no reported complications with this [ESP] block.”1 Local anesthetic systemic toxicity is not a theoretical complication—it has been well described in this setting,2 as has pneumothorax and other complications.2,3 Finally, we agree that the risk of bleeding from a peripheral nerve block in patients receiving antithrombotic agents or after full anticoagulation—a regular occurrence in those presenting for cardiac surgery—remains unclear. However, guidelines for performing these techniques under these circumstances do exist,4 and until evidence about the safety of fascial plane blocks in cardiac surgery emerges, they are the best guide available to our practice. Camila M. de Souza, PhD, FRCPCDuncan Maguire, MDDepartment of AnesthesiologyPerioperative and Pain MedicineUniversity of ManitobaWinnipeg, Manitoba, Canada[email protected]
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.004 | 0.002 |
| Research integrity | 0.019 | 0.024 |
| Insufficient payload (model declined to judge) | 0.011 | 0.008 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".