Contrast Spread After Erector Spinae Plane Block at the Fourth Lumbar Vertebrae: A Cadaveric Study

Breidenbach, Kathryn A; Wahezi, Sayed E.; Kim, Soo Yeon; Koushik, Sarang; Gritsenko, Karina; Shaparin, Naum; Kaye, Alan D.; Viswanath, Omar; Wu, Hall; Kim, Jung Ho

doi:10.1007/s40122-022-00453-2

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…The discontinuous lumbar paravertebral space renders lumbar ESPB spread between adjacent levels less reliable than in the thoracic region [ 19 ]. Several cadaveric studies attempted to evaluate the actual mechanism of ESPBs in the lumbar region [ 20 , 21 , 22 ]. Harbell et al performed nine ESPB injections of 20 mL of methylene blue at L4 on five cadavers, and dissections performed at least two hours after the nine injections found a more localized lumbar ESPB spread than its thoracic counterpart, which they suspected to result from the complex thoracolumbar fascia and thickness of the lumbar musculature [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Onset Time of Lumbar Erector Spinae Plane Block Compared with Its Thoracic Counterpart: Case Reports

et al. 2023

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The erector spinae plane block (ESPB) at the level of the fifth thoracic vertebra (T5) is a novel technique, first published in 2016, which was found to be effective in both acute and chronic pain control. The mechanism of action and spread of local anesthetic of the ESPB at the lumbar region are thought to differ from those of the thoracic ESPB; however, the difference in onset time has never been evaluated. As for the onset of lumbar ESPBs, we presented three cases: two received lumbar ESPBs (one with chronic low back pain and one with acute postoperative hip pain), and the third one with chronic back pain received a thoracic ESPB. We administered 30 mL of 0.3% ropivacaine in all three patients, but the analgesic effect did not reach its maximum until 3 and 1.5 h, respectively, in the lumbar ESPB cases. On the contrary, the thoracic ESPB case experienced noticeable pain relief within 30 min. The onset time was considerably longer than that reported in earlier reports on ESPBs, and the lumbar ESPB achieved its peak effect much later than the thoracic ESPB using the same formula of local anesthetic. While the delayed-onset lumbar ESPB may have some drawbacks for treating acute postoperative pain, it still could produce significant analgesia, once it took effect, when given to patients suffering from hip surgery with large incisions and intractable low back pain. The current data suggested that the onset time of a lumbar ESPB may be delayed compared with its thoracic counterpart. Therefore, the local anesthetic formula and injection timing should be adjusted for a lumbar ESPB when applied in the perioperative period to make the onset of the analgesic effect coincide with the immediate postoperative pain. Without this concept in mind, clinicians may consider a lumbar ESPB to be ineffective before it takes effect, and consequently treat the patients inadequately with this technique. Future randomized controlled trials should be designed according to our observations to compare lumbar ESPB with its thoracic counterpart regarding onset time.

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Section: Discussionmentioning

confidence: 99%

Onset Time of Lumbar Erector Spinae Plane Block Compared with Its Thoracic Counterpart: Case Reports

et al. 2023

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“…This suggests that the local anaesthetic may not only spread in a fascial plane to lumbar and sacral nerve root branches but also migrate to the epidural space [13]. However, we are unaware of any dye studies to date that support this hypothesis [14].…”

Section: Discussionmentioning

confidence: 99%

Unilateral sacral erector spinae plane block for hip fracture surgery

Marrone,

Paventi,

Tomei

et al. 2024

Anaesthesia Reports

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SummaryThe provision of anaesthesia for hip fracture surgery in elderly and frail patients can be challenging, with potentially significant risks associated with both general and neuraxial techniques. Here, we report the use of a sacral erector spinae plane block as an alternative to conventional anaesthetic approaches for a frail 89‐year‐old woman with significant cardiovascular and respiratory comorbidity who underwent intramedullary nailing for a proximal femoral fracture. A unilateral injection of local anaesthetic at the intermediate crest of the second sacral vertebra resulted in bilateral sensory block of the T12 to S2 dermatomes. The technique did not result in hypotension or motor block of the limbs, and the surgery was completed uneventfully. Sacral erector spinae plane block warrants further investigation as an alternative to spinal and general anaesthesia for hip and lower limb surgery.

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“…The needle in the psoas muscle was pulled back to the depth at which it touched the transverse process of the L4. The needle was pulled back 0.5~1 cm further from the depth where the transverse process was touched and 2.5 cc of atelocollagen mixture was injected into the erector spinae (Figure 2c) [11,32]. Third, the needle in the current position was adjusted to the medial side so that the needle could touch the laminar or spinous process.…”

Section: Atelocollagen Injectionmentioning

confidence: 99%

Effects of Paraspinal Intramuscular Injection of Atelocollagen in Patients with Chronic Low Back Pain: A Retrospective Observational Study

Kim,

Gil

2024

JCM

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Background/Objectives: Atelocollagen is used for soft tissue repair and reconstruction by replacing defective or damaged muscles, membranes, ligaments, and tendons. This study aimed to evaluate the clinical efficacy and safety of additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection for reducing pain and improving functional capacity of patients with chronic low back pain (CLBP). Methods: We retrospectively enrolled 608 consecutive patients with CLBP who received lumbar epidural steroid injection with or without additional paraspinal intramuscular injection of atelocollagen. The Numerical Rating Scale and the Oswestry Disability Index were used to assess pain and functional capacity, respectively, before the procedure, and three months after the injection. Also, we analyzed the relationship between the additional paraspinal intramuscular injection of atelocollagen and the success rate. Results: Both Numerical Rating Scale and the Oswestry Disability Index scores were significantly reduced in both groups at three months after injection. However, there was a significant difference between the two groups. Furthermore, the success rate was significantly higher in the additional paraspinal intramuscular injection of atelocollagen group. Conclusions: This study’s results showed that additional paraspinal intramuscular injection of atelocollagen on lumbar epidural steroid injection reduced pain and improved functional capacity for patients with CLBP. Therefore, the paraspinal intramuscular injection of atelocollagen may be a promising option for the treatment of patients with CLBP.

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Contrast Spread After Erector Spinae Plane Block at the Fourth Lumbar Vertebrae: A Cadaveric Study

Cited by 8 publications

References 27 publications

Onset Time of Lumbar Erector Spinae Plane Block Compared with Its Thoracic Counterpart: Case Reports

Onset Time of Lumbar Erector Spinae Plane Block Compared with Its Thoracic Counterpart: Case Reports

Unilateral sacral erector spinae plane block for hip fracture surgery

Effects of Paraspinal Intramuscular Injection of Atelocollagen in Patients with Chronic Low Back Pain: A Retrospective Observational Study

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