• regional anesthesia
• nerve block
• pain management

To the editor

We read with great interest the recent article published by El-Boghdadly et al1 on behalf of the team of international regional anesthesia experts to standardized the nomenclature of regional anesthetic techniques and we would like to congratulate their efforts. We wholeheartedly agree that the need for standardization is an important step in improving the accessibility of regional anesthesia for both clinicians and patients.

We do, however, believe that transversus thoracic plane (TTP) block has been incorrectly grouped under the superficial parasternal intercostal plane block and we would like to seek further clarification for this decision. The original description of this block was by Ueshima and Kitamura in 2015.2 They described an ultrasound-guided injection in the plane between the transversus thoracic muscle and the internal intercostal muscle at the level of the third and fourth rib and a subsequent cadaveric study3 showed 15 mL of dye injected in this area provided coverage of the anterior branches of intercostal nerves of T2 and T5. Further clinical studies using this technique showed benefit in both cardiac and breast surgery involving the anterior chest.4 5

This description of the TTP block is more in line with the newly defined deep parasternal intercostal plane block, described as in ‘the plane between the internal intercostal and the transversus thoracis muscle’ opposed to the superficial parasternal intercostal plane block, described as in ‘the planes superficial to the internal intercostal muscles and ribs and deep to the pectoralis major muscle’.

Despite this inconsistency, we commend the representatives from both the American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy in their goal in homogenizing the multitude of regional anesthetic blocks described in literature. They have provided clear and concise anatomical descriptions for these blocks, which we believe will help advance the standard of evidence for regional anesthesia.