Is Paravertebral-Epidural Spread the Underlying Mechanism of Action of Erector Spinae Plane Block?

Diwan, Sandeep; Nair, Abhijit

doi:10.5152/tjar.2019.81226

Cited by 16 publications

(5 citation statements)

References 3 publications

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“…This is bolstered by radiological imaging in living subjects showing radiocontrast spread into the paravertebral and even epidural space across multiple levels. [37][38][39][40] The posterior thoracolumbar fascia and intertransverse connective tissue complex (a collective term for the ligaments, muscles, and other connective tissues that span adjacent transverse processes) 41 is perforated by branches of the dorsal rami and accompanying blood vessels, 42,43 and these are the most likely pathways for local anesthetic to track into the paravertebral space (Fig. 1).…”

Section: Physical Spread Of Local Anesthetic To the Thoracic Paravertebral Space And Associated Neural Structuresmentioning

confidence: 99%

“…Epidural spread in particular has been documented on MR or CT imaging in live subjects following ESP blocks. 37,39,40,88 While this central neuraxial spread may not always be in physically detectable amounts, it may nevertheless be sufficient to produce therapeutic local anesthetic concentrations in the milieu surrounding the spinal nerve roots, dorsal root ganglia, or dorsal horn of the spinal cord, thus inhibiting nociceptive transmission and central sensitization in the same way that plasma-borne lidocaine is believed to act. These low neuraxial concentrations of local anesthetic would not, however, be expected to produce the same clinical effects (with regard to both quality of anesthesia and sympatholysis) as an appropriately dosed epidural anesthetic, where a much larger mass of drug is deposited directly around the neuraxis.…”

Section: Effects Of Injected Local Anesthetic On the Spinal Cordmentioning

confidence: 99%

See 1 more Smart Citation

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

261

168

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Section: Physical Spread Of Local Anesthetic To the Thoracic Paravertebral Space And Associated Neural Structuresmentioning

confidence: 99%

Section: Effects Of Injected Local Anesthetic On the Spinal Cordmentioning

confidence: 99%

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

261

168

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“…Cadaveric and radiocontrast studies depict a dorsal and a ventral spread into the PVS. [ 6 7 ] In our case series, the spread from the ESPB was in the thoracic PVS in both the patients at the level of T5.…”

mentioning

confidence: 59%

Spread of local anesthetic after thoracic erector spinae and thoracic paravertebral block in patients with multiple posterolateral rib fractures

Diwan

Nair

2020

Saudi J Anaesth

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“…The ventral diffusion of erector spinae plane block has been demonstrated in a previous cadaveric and clinical study. [ 11 12 ] However, the subsequent cadaveric and clinical study illustrated an unpredictable diffusion and a dorsal rami block. [ 13 14 ] This could be the reason for the highly variable clinical efficacy of erector spinae plane block.…”

Section: Discussionmentioning

confidence: 99%

Pathways of dye spread after injections in the paraspinal spaces—A cadaveric study

Diwan,

Shivamallappa,

Timane

et al. 2024

Saudi Journal of Anaesthesia

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Background: The erector spinae plane (ESP) block is the most sought-after block since its inception. However, it is more of dorsal rami block with unpredictable ventral diffusion to the paravertebral area. We injected dye in ESP and other paraspinal spaces to study and compare the dye diffusion pattern along the neuroaxis and paraspinal region in human cadavers. Methods: In six soft-embalmed cadavers (12 specimens), 20 mL methylene blue dye (erector spinae plane and paravertebral space) or indocyanine green dye (inter-ligament space) was injected bilaterally using an in-plane ultrasound-guided technique at the level of the costotransverse junction of fourth thoracic vertebrae. Dye spread was evaluated bilaterally in the coronal plane in the paravertebral and intercostal spaces from the 1st and the 12th rib. Axial and sagittal sections were performed at the level of the 4th thoracic vertebrae. After cross sections, the extent of dye spread was investigated in ESP, inter-ligament, and paravertebral spaces. The staining of the ventral and dorsal rami and spread into the intercostal spaces was evaluated. Results: ESP injection was mainly restricted dorsal to the costotransverse foramen and did not spread anteriorly to the paravertebral space. The paravertebral injection involved the origin of the spinal nerve and spread laterally to the intercostal space. The inter-ligament space injection showed an extensive anterior and posterior dye spread involving the ventral and dorsal rami. Conclusions: Following ESP injection, there was no spread of the dye anteriorly to the paravertebral space and it only involved the dorsal rami. Inter-ligamentous space injection appears to be the most promising block as dye spread both anteriorly to paravertebral space and posteriorly toward ESP.

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Is Paravertebral-Epidural Spread the Underlying Mechanism of Action of Erector Spinae Plane Block?

Cited by 16 publications

References 3 publications

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Spread of local anesthetic after thoracic erector spinae and thoracic paravertebral block in patients with multiple posterolateral rib fractures

Pathways of dye spread after injections in the paraspinal spaces—A cadaveric study

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