Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study

Aponte, Adriana; Sala-Blanch, Xavi; Prats-Galino, Alberto; Masdeu, Joseph C.; Moreno, L.; Sermeus, Luc

doi:10.1007/s12630-019-01399-4

Cited by 99 publications

(78 citation statements)

References 25 publications

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“…It has been reported that single-injection ESP block require more morphine [7]. Recently, a cadaveric study conducted by Aponte et al [12] indicated that the dye and contrast agents diffuse in a cephalad-to-caudal direction in the dorsal region of T1-T11, and laterally diffuse to the ribs, as demonstrated by CT scan and anatomical observation. Moreover, no dye or contrast agent was observed to spread to the paravertebral region.…”

Section: Backgroudmentioning

confidence: 96%

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Zhang

Wang

et al. 2020

BMC Anesthesiol

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Background: Ultrasound-guided erector spine plane (ESP) block is widely used in perioperative analgesia for back, chest and abdominal surgery. The extent and distribution of this block remain controversial. This study was performed to assess the analgesia range of an ultrasound-guided ESP block. Methods: This prospective observational volunteer study consisted of 12 healthy volunteers. All volunteers received an erector spinae plane block at the left T5 transverse process using real-time ultrasound guidance. Measured the cutaneous sensory loss area (CSLA) and cutaneous sensory declination area (CSDA) using cold stimulation at different time points after blockade until its disappearance. The CSLA and CSDA were mapped and then calculated. The block range was described by spinous process level and lateral extension. The effective block duration for each volunteer was determined and recorded. Results: The cold sensory loss concentrates at T6-T9. The decline concentrates primarily at T4-T11. The lateral diffusion of block to the left side did not cross the posterior axillary line, and reached the posterior median line on the right. The area of cutaneous sensory loss was (172 ± 57) cm 2 , and the area of cutaneous sensory decline was (414 ± 143) cm 2. The duration of cutaneous sensory decline was (586 ± 28) minutes. Conclusion: Ultrasound-guided erector spine plane block with 20 mL of 0. 5% ropivacaine provided a widespread cutaneous sensory block in the posterior thorax, but did not reach the anterior chest, lateral chest, or abdominal walls. The range of the blockade suggested that the dorsal branch of spinal nerve was blocked.

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Section: Backgroudmentioning

confidence: 96%

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Zhang

Wang

et al. 2020

BMC Anesthesiol

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“…Based on this mechanism, Coşarcan SK et al [27] reported a modification ESPB and got good pain relief in various surgeries. However, the mechanism of paravertebral spread of LA remained debated in several cadaveric studies [28][29][30]. Another potential mechanism is epidural spread of LA.…”

Section: Possible Mechanisms For Findingsmentioning

confidence: 99%

Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials

Huang

Liu

2020

BMC Anesthesiol

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Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its effectiveness remain uncertain. This meta-analysis aimed to determine the clinical efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 12 RCTs consisting of 590 patients were included. Ultrasound-guided ESPB showed a reduction of intravenous opioid consumption 24 h after surgery (SMD = − 2.18; 95% confidence interval (CI)-2.76 to − 1.61,p < 0.00001). Considerable heterogeneity was observed (87%). It further reduced the number of patients who required postoperative analgesia (RR = 0.41,95% CI 0.25 to 0.66,p = 0,0002) and prolonged time to first rescue analgesia (SMD = 4.56,95% CI 1.89 to 7.22, p = 0.0008). Conclusions: Ultrasound-guided ESPB provides effective postoperative analgesic in adults undergoing GA surgeries.

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“…An emerging PNB is the erector spinae plane (ESP) block, in which local anesthetic is injected into the fascial plane deep to the erector spinae muscle superficial to the transverse process . The local anesthetic spreads craniocaudally through the fascial plane as well as anteriorly and laterally to the paravertebral and intercostal spaces . The procedure has a significant amount of craniocaudal spread, with a cadaveric study demonstrating spread from T1 to T11 with injection of 20 mL of dye at T7 .…”

Section: Introductionmentioning

confidence: 99%

“…The local anesthetic spreads craniocaudally through the fascial plane as well as anteriorly and laterally to the paravertebral and intercostal spaces . The procedure has a significant amount of craniocaudal spread, with a cadaveric study demonstrating spread from T1 to T11 with injection of 20 mL of dye at T7 . It has been used perioperatively for acute pain management after thoracoabdominal surgeries such as cardiopulmonary bypass, breast cancer resection, and cholecystectomy .…”

Section: Introductionmentioning

confidence: 99%

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

2020

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Background Peripheral nerve blocks (PNBs) are used for a wide spectrum of headache and facial pain disorders. The objective of this case report is to highlight the erector spinae plane (ESP) block, which has recently been reported to successfully treat headache. Case Presentation A 70‐year‐old man with a history of mild to moderate headaches, previously ruptured aneurysm, and right pterional craniotomy and clipping of an anterior communicating artery aneurysm presented with exacerbation of chronic post‐surgical scalp pain and severe headache with nausea. Results of the physical examination were not consistent with cellulitis of the scalp, complete blood count and chemistry panel results were unremarkable, and imaging revealed an intact aneurysm clip. Given the severe unilateral throbbing pain with associated nausea, he was treated with a variety of migraine abortives and other pain medications without significant relief. ESP block was performed. He tolerated the procedure well without complications. His pain decreased to 2/10 from a baseline of 9 to 10/10 30 minutes after the procedure, and he was pain free the next day. Follow‐up revealed a return of his pain 1 to 2 weeks after the procedure, which prompted follow‐up with an outpatient pain management specialist. Conclusion PNBs, ESP block in our case, can be a useful modality in managing chronic neuralgiform pain for treatment‐refractory patients. It can provide improvement in quality of life and spare the patient from medication side effects. In an inpatient setting, it can decrease length of stay that would otherwise be extended due to a trial of multiple medications until the pain was controlled. PNBs are used for a wide spectrum of headache and facial pain disorders. This case report highlights successful management of chronic neuralgiform pain with the ESP block, which has recently been reported to successfully treat headache. ESP block provided relief to the patient's neuralgiform pain that was refractory to multiple medications, resulting in decreased length of stay, fewer medication side effects, and improved quality of life. It also provided a window for initiation of long‐term pain medications.

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Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study

Cited by 99 publications

References 25 publications

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Ultrasound-guided erector spinae plane block for postoperative analgesia: a meta-analysis of randomized controlled trials

Case Report: Treatment of Refractory Post‐Surgical Neuralgia With Erector Spinae Plane Block

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