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Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study

Évaluation anatomique de la propagation du bloc du plan des muscles érecteurs du rachis: une étude cadavérique

Abstract

Purpose

The erector spinae plane (ESP) block is an interfascial analgesic technique first described as an alternative for pain control at the thoracic level. The objective of this observational study was to determine the anatomical spread of dye following a T7 ESP block in a cadaveric model.

Methods

An ultrasound-guided ESP block was performed in four fresh human cadavers using an in-plane approach with a linear probe in a longitudinal orientation and a puncture in a craniocaudal direction. Twenty millilitres of an iodinated contrast/methylene blue solution was injected deep to the erector spinae muscle at the distal end of the T7 transverse process bilaterally in two of the specimens, and unilaterally in the other two (six ESP blocks in total). Subsequently, the specimens were subjected to a multi-slice computed tomography (CT) scan with three-dimensional reconstruction. Two of the specimens were dissected to evaluate the distribution of the contrast solution, and a sectional study was performed in the other two.

Results

In the six samples, evaluated by CT scan and anatomical dissection, a craniocaudal spread of the dye was observed in the dorsal region from T1–T11 with lateral extension towards the costotransverse region. No diffusion of contrast solution or dye to the anterior region (paravertebral space) was observed by CT scan or dissection.

Conclusions

The results suggest that the ESP block reaches a wide range of the posterior rami of spinal nerves without diffusion into the paravertebral space or involvement of the anterior rami.

Résumé

Objectif

Le bloc du plan des muscles érecteurs du rachis (ESP) est une technique analgésique interfasciale qui avait d’abord été décrite comme une alternative pour contrôler la douleur au niveau thoracique. L’objectif de cette étude observationnelle était de déterminer la propagation anatomique d’un colorant après la réalisation d’un bloc ESP au niveau T7 dans un modèle cadavérique.

Méthode

Un bloc ESP a été réalisé sous échoguidage sur quatre cadavres humains frais en utilisant une approche dans le plan avec une sonde linéaire en orientation longitudinale et une ponction en direction cranio-caudale. Vingt millilitres d’une solution de contraste iodée / bleu de méthylène ont été injectés postérieurement aux muscles érecteurs du rachis à l’extrémité distale de l’apophyse transverse T7, bilatéralement dans deux des spécimens et unilatéralement dans les deux autres (soit six blocs ESP au total). Par la suite, les spécimens ont été soumis à une tomodensitométrie multicoupe avec reconstruction en 3D. Deux des spécimens ont été disséqués afin d’évaluer la distribution de la solution de contraste, et une étude sectionnelle a été réalisée sur les deux autres spécimens.

Résultats

Dans les six échantillons évalués par tomodensitométrie et dissection anatomique, une propagation cranio-caudale du colorant a été observée dans la région dorsale de T1–T11 avec une extension latérale vers la région costo-transverse. La tomodensitométrie et la dissection n’ont révélé aucune propagation de la solution de contraste ou du colorant à la région antérieure (espace paravertébral).

Conclusion

Ces résultats suggèrent que le bloc ESP atteint de nombreux rameaux postérieurs des nerfs rachidiens sans diffusion dans l’espace paravertébral ou atteintes des rameaux antérieurs.

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Competing interests

No external funding and no competing interests declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Adriana Aponte and Xavi Sala-Blanch conceived the study, participated in its design and coordination, performed the blocks and dissection, and wrote the manuscript. Alberto Prats-Galino participated in anatomy dissection and analysis. Joseph Masdeu helped in writing the manuscript. Luis A. Moreno helped in conceiving the study and performed the blocks. Luc A. Sermeus helped to conceive the study, helped to draft the manuscript, and performed a critical reading of the manuscript.

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Correspondence to Luc A. Sermeus PhD.

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This article is accompanied by an editorial. Please see Can J Anesth 2019; 66: this issue.

Electronic supplementary material

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VIDEO Image showing the spread of contrast solution and the calcifications in a series of axial computed tomography slices of the trunk after an erector spinae plane block. Supplementary material 1 (M4V 4828 kb)

VIDEO Image showing the spread of contrast solution and the calcifications in a series of axial computed tomography slices of the trunk after an erector spinae plane block. Supplementary material 1 (M4V 4828 kb)

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Aponte, A., Sala-Blanch, X., Prats-Galino, A. et al. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anesth/J Can Anesth 66, 886–893 (2019) doi:10.1007/s12630-019-01399-4

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