The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study
Tóm tắt
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.
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.
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) cm2, and the area of cutaneous sensory decline was (414 ± 143) cm2. The duration of cutaneous sensory decline was (586 ± 28) minutes.
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.
Chinese Clinical Trial Registry,
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Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector Spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.
Forero M, Rajarathinam M, Adhikary S, Chin KJ. Continuous erector Spinae plane block for rescue analgesia in thoracotomy after epidural failure: a case report. A A Case Rep. 2017;8(10):254–6.
Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med. 2019;7(8):174.
Chin KJ, Malhas L, Perlas A. The erector Spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–6.
Ueshima H, Otake H. Clinical experiences of ultrasound-guided erector spinae plane block for thoracic vertebra surgery. J Clin Anesth. 2017;38:137.
Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101–6.
Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Clin Anesth. 2019;59:106–11.
Altiparmak B, Korkmaz Toker M, Uysal AI, Gumus Demirbilek S. Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019;19(1):31.
Gaweda B, Borys M, Belina B, Bak J, Czuczwar M, Woloszczuk-Gebicka B, Kolowca M, Widenka K. Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial. BMC Anesthesiol. 2020;20(1):51.
Oksuz G, Bilgen F, Arslan M, Duman Y, Urfalioglu A, Bilal B. Ultrasound-guided bilateral erector Spinae block versus tumescent anesthesia for postoperative analgesia in patients undergoing reduction mammoplasty: a randomized controlled study. Aesthet Plast Surg. 2019;43(2):291–6.
Abu Elyazed MM, Mostafa SF, Abdelghany MS, Eid GM. Ultrasound-guided erector Spinae plane block in patients undergoing open Epigastric hernia repair: a prospective randomized controlled study. Anesth Analg. 2019;129(1):235–40.
Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth. 2019;66(8):886–93.
Cosarcan SK, Dogan AT, Ercelen O, Gurkan Y. Superior costotransverse ligament is the main actor in permeability between the layers? Target-specific modification of erector spinae plane block. Reg Anesth Pain Med 2019.
Tulgar S, Ahiskalioglu A, Thomas DT, Gurkan Y. Should erector spinae plane block applications be standardized or should we revise nomenclature? Reg Anesth Pain Med. 2020;45(4):318–19.
Ueshima H, Otake H. Limitations of the erector Spinae plane (ESP) block for radical mastectomy. J Clin Anesth. 2018;51:97.
Drennen A. Erector spinae block to reduce pain after reduction mammoplasty: we need more evidence. Aesthetic Plast Surg. 2019;43(5):1406–7.
Taketa Y, Irisawa Y, Fujitani T. Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax. J Clin Anesth. 2018;47:84–5.
Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector Spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. A A Case Rep. 2017;9(11):319–21.
Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452–60.
Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Can J Anaesth. 2018;65(10):1165–6.
Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: a case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Ind J Anaesth. 2018;62(1):75–8.
Vidal E, Giménez H, Forero M, Fajardo M. Erector spinae plane block: a cadaver study to determine its mechanism of action. Rev Esp Anestesiol Reanim. 2018;65(9):514–9.
Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73(10):1244–50.
Otero PE, Fuensalida SE, Russo PC, Verdier N, Blanco C, Portela DA. Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model. Reg Anesth Pain Med. 2020;45(3):198–203.
Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector Spinae blockade. Reg Anesth Pain Med. 2018;43(6):567–71.
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36.
Munoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. 2017;64(8):880–2.