Altinpulluk Ece Yamak, Ozdilek Aylin, Colakoglu Nilgun, Beyoglu Cigdem Akyol, Ertas Ahmet, Uzel Mehmet, Yildirim Fatma Guler, Altindas Fatis
Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpaşa, Cerrahpaşa Medical Faculty, Turkey.
Department of Anatomy, Istanbul University Cerrahpaşa, Cerrahpaşa Medical Faculty, Turkey.
Rom J Anaesth Intensive Care. 2019 Apr;26(1):83-88. doi: 10.2478/rjaic-2019-0013.
We anticipated that bilateral Erector spinae plane (ESP) block, which was applied in 10 patients starting from lower thoracic levels (T9) might provide effective postoperative analgesia in open abdominal hysterectomies. In addition, we aimed to obtain anatomic observation of the local anaesthetic (LA) spread in the ESP block by injecting methylene blue on 4 cadavers. All the patients had excellent pain relief. There was an extensive spread to the erector spinae muscle (ESM) involving several segmental levels on cadavers. We observed the spread of dye on the ventral and dorsal rami in the paravertebral space and as an additional finding, the dye had extended to the canal vertebralis. There was a spread of dye on the dura mater. ESP block can be used with new indications and it is an effective technique for major abdominal surgery when is applied to the lower vertebral levels. Randomized controlled trials are required to explore the clinical implications of our findings.
我们预计，从胸段下部（T9）开始对10例患者实施的双侧竖脊肌平面（ESP）阻滞，可能会为开放性腹部子宫切除术提供有效的术后镇痛。此外，我们旨在通过在4具尸体上注射亚甲蓝来观察ESP阻滞中局部麻醉药（LA）的扩散情况。所有患者的疼痛均得到了极好的缓解。在尸体上，局部麻醉药广泛扩散至竖脊肌（ESM），涉及多个节段水平。我们观察到染料在椎旁间隙的腹侧和背侧支上扩散，另外还发现染料延伸至椎管。硬脑膜上也有染料扩散。ESP阻滞可用于新的适应证，当应用于较低椎体水平时，它是一种用于大型腹部手术的有效技术。需要进行随机对照试验来探究我们研究结果的临床意义。
