Erector spinae plane block: A cadaver study to determine its mechanism of action

Vidal, E.; Gimenez, Hercules; Forero, Mauricio; Pérez, Mario Fajardo

doi:10.1016/j.redare.2018.09.002

Cited by 61 publications

(73 citation statements)

References 21 publications

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“…Perhaps this increased volume is enough to overcome the barrier of the costotransverse foramen and reach the paravertebral space and ventral rami? This would be consistent with our clinical observations as well as a smaller cadaver study2 that found spread to the paravertebral and intercostal spaces (though it should be noted this study also used 20cc volumes). Alternatively, this disparity could be explained by variability in injection pressures leading to inconsistent spread.…”

supporting

confidence: 91%

Cadaveric study investigating the mechanism of action of erector spinae blockade

Schoenfeldt¹,

Guffey²,

Fingerman³

2019

Regional Anesthesia &Amp; Pain Medicine

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supporting

confidence: 91%

Cadaveric study investigating the mechanism of action of erector spinae blockade

Schoenfeldt¹,

Guffey²,

Fingerman³

2019

Regional Anesthesia &Amp; Pain Medicine

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“…Nuclear magnetic resonance studies by Adhikary et al [21] and Schwartzmann et al [20] suggested that contrast agents can enter the paravertebral space, and even the epidural space. Further cadaveric studies [22,23] also suggested that dyes can enter the paravertebral area. However, other studies have raised concerns and objections.…”

Section: Fig 2 Marked Lines and Pointsmentioning

confidence: 99%

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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“…There is also a need to determine the ideal injectate composition for evaluating injectate spread following regional analgesic techniques. Injectates used in the evaluation of cadaveric spread have been variable in composition and consistency, and include methylene blue [9][10][11] and latex, 8 both of which have been used in ESP studies; more complex formulations have been used for other interfascial plane blocks. 23,24 The varying viscosity of these solutions may impact the resultant spread as aqueous dyes may diffuse more easily through tissues compared with viscous dyes.…”

Section: Anatomical Studies On Interfascial Plane Blocks: Extrapolatementioning

confidence: 99%

“…Current evidence for the spread of an ESP injectate into the paravertebral space (PVS) is somewhat conflicting, with studies both supporting [8][9][10] and refuting 11 the spread of the injectate through the costo-transverse ligament into the PVS following an ESP block. There are several methodological issues common to cadaveric studies that might be responsible for these discrepancies.…”

mentioning

confidence: 99%

“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

Sondekoppam

Tsui

2019

Can J Anesth/J Can Anesth

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Erector spinae plane block: A cadaver study to determine its mechanism of action

Cited by 61 publications

References 21 publications

Cadaveric study investigating the mechanism of action of erector spinae blockade

Cadaveric study investigating the mechanism of action of erector spinae blockade

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

“Minimally invasive” regional anesthesia and the expanding use of interfascial plane blocks: the need for more systematic evaluation

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