Injectate spread in ESP block: A review of anatomical investigations

Cassai, Alessandro De; Andreatta, Giulio; Bonvicini, Daniele; Boscolo, Annalisa; Munari, Marina; Navalesi, Paolo

doi:10.1016/j.jclinane.2019.109669

Cited by 30 publications

(22 citation statements)

References 18 publications

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“…Recent literature has reported that different volumes of local anesthetic injectate and its corresponding spread are influenced by the site of injection. For example, a 5 mL of injectate was needed to cover one vertebral level in the lumbar region, whereas only 3.3 (radiological imaging studies) to 3.5 (cadaveric dissections studies) mL are needed in thoracic region [45]. In our study, we found that patients who underwent spine or orthopedic surgeries compared to control experienced clinical pain relief at 6 h which dissipated by 12 h after surgery.…”

Section: Discussionmentioning

confidence: 59%

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

et al. 2020

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Background: The effect of erector spinae plane block has been evaluated by clinical trials leading to a diversity of results. The main objective of the current investigation is to compare the analgesic efficacy of erector spinae plane block to no block intervention in patients undergoing surgical procedures. Methods: We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases from their inception through July 2019. Included trials reported either on opioid consumption or pain scores as postoperative pain outcomes. Methodological quality of included studies was evaluated using Cochrane Collaboration's tool. Results: Thirteen randomized controlled trials evaluating 679 patients across different surgical procedures were included. The aggregated effect of erector spinae plane block on postoperative opioid consumption revealed a significant effect, weighted mean difference of − 8.84 (95% CI: − 12.54 to − 5.14), (P < 0.001) IV mg morphine equivalents. The effect of erector spinae plane block on post surgical pain at 6 h compared to control revealed a significant effect weighted mean difference of − 1.31 (95% CI: − 2.40 to − 0.23), P < 0.02. At 12 h, the weighted mean difference was of − 0.46 (95% CI: − 1.01 to 0.09), P = 0.10. No block related complications were reported. Conclusions: Our results provide moderate quality evidence that erector spinae plane block is an effective strategy to improve postsurgical analgesia.

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Section: Discussionmentioning

confidence: 59%

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

et al. 2020

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“…It consists of an injection of the local anesthetic in a fascial plane placed between erector spinae muscles and the tip of the transverse vertebral process [1]. The anesthetic spreads over the fascial plane both in the cranial and caudal direction, also diffusing anteriorly and laterally at several levels by one dermatome per 3.4 mL of injected liquid [2]. It provides analgesia in a wide range of different clinical scenarios [3,4].…”

Section: Introductionmentioning

confidence: 99%

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

et al. 2020

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Purpose Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block. Methods The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50 mm needle), using diluted black tissue marking dye (20 mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed. Results Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10 cm laterally, and on the ventral side of the chest from T2/3–T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2–3 and 5–6 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen. Conclusions The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block.

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“…Consequently, craniocaudal spread of ESPB is more limited in the lumbar region when compared to the thoracic region. 13 Craniocaudal spreading is related to the spreading in the fascial plane, but due to the size of the vertebra, the area of the fascial plane where the LA will spread (in proportion to the muscle size), the differences observed in the structure of the fascia between the thoracic and lumbar regions, and the differences in the anatomical barriers that may be effective in the transition to the anterior region. In a review in the literature where anatomical investigations are evaluated, it is stated that; a median of 3.3 mL of local anesthetic was needed to cover one vertebral level when considering the whole vertebral column, whereas 2.5 mL was needed for thoracic and 5 mL were needed for the lumbar area.…”

Section: Anatomic Considerations In Espbmentioning

confidence: 99%

“…In a review in the literature where anatomical investigations are evaluated, it is stated that; a median of 3.3 mL of local anesthetic was needed to cover one vertebral level when considering the whole vertebral column, whereas 2.5 mL was needed for thoracic and 5 mL were needed for the lumbar area. 13 It should be kept in mind that as the application point is deeper and more latera, lumbar ESPB is more challenging to perform and to more difficult to sonographicallyvisualize when compared to thoracic applications. 14…”

Section: Anatomic Considerations In Espbmentioning

confidence: 99%

“…In a minireview, the relationship between injectate volume and anatomical distribution and differences were revealed separately in thoracic and lumbar ESPB. 13 In this article, a 5 mL local anesthetic application is recommended for each lumbar nerve blockade in lumbar ESPB. The anatomic spread of LA in lumbar ESPB has been reported in only a few clinical/cadaveric studies and case reports.…”

Section: The Spread Of Injectate; Anatomical Studies and Radiologicalmentioning

confidence: 99%

See 1 more Smart Citation

<p>Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block</p>

Tulgar¹,

Aydın²,

Ahıskalıoğlu³

et al. 2020

LRA

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Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in "Pubmed" and "Google Scholar" database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.

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Injectate spread in ESP block: A review of anatomical investigations

Cited by 30 publications

References 18 publications

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

<p>Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block</p>

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