Spread of local anesthetics after erector spinae plane block: an MRI study in healthy volunteers.
Reg Anesth Pain Med
; 48(2): 74-79, 2023 02.
Article
in En
| MEDLINE
| ID: mdl-36351741
ABSTRACT
BACKGROUND:
Erector spinae plane block (ESPB) is a truncal fascial block with a disputed mechanism and anatomical site of effect. This study aimed to perform a one-sided ESPB and use MRI to investigate the spread of the local anesthetic (LA) and the corresponding cutaneous loss of sensation to pinprick and cold.METHODS:
Ten volunteers received a right-sided ESPB at the level of the seventh thoracic vertebra (Th7), consisting of 30 mL 2.5 mg/mL ropivacaine with 0.3 mL gadolinium. The primary outcome was the evaluation of the spread of LA on MRI 1-hour postblock. The secondary outcome was the loss of sensation to cold and pinprick 30-50 min after the block was performed.RESULTS:
All volunteers had a spread of LA on MRI in the erector spinae muscles and to the intercostal space. 9/10 had spread to the paravertebral space and 8/10 had spread to the neural foramina. 4/10 volunteers had spread to the epidural space. One volunteer had extensive epidural spread as well as contralateral epidural and foraminal spread. Four volunteers had a loss of sensation both posterior and anterior to the midaxillary line, while six volunteers had a loss of sensation only on the posterior side.CONCLUSION:
We found that LA consistently spreads to the intercostal space, the paravertebral space, and the neural foramina after an ESPB. Epidural spread was evident in four volunteers. Sensory testing 30-50 min after an ESPB shows highly variable results, and generally under-represents what could be expected from the visualized spread on MRI 60 min after block performance. TRIAL REGISTRATION NUMBER NCT05012332.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anesthetics, Local
/
Nerve Block
Limits:
Humans
Language:
En
Journal:
Reg Anesth Pain Med
Journal subject:
ANESTESIOLOGIA
/
NEUROLOGIA
/
PSICOFISIOLOGIA
Year:
2023
Document type:
Article
Affiliation country:
Noruega