Department of Anatomy, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.
Department of Anatomy, Section of Clinical Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Gauteng, South Africa.
Paediatr Anaesth. 2020 Nov;30(11):1216-1223. doi: 10.1111/pan.14009. Epub 2020 Sep 27.
Since its inception, the erector spinae plane block has been used for a variety of truncal surgeries with success in both adults and children. However, the anatomical features, route of spread, and dermatomal coverage are still not fully understood in a pediatric population.
To identify the anatomical features of the erector spinae fascial plane space by replicating an erector spinae plane block in a fresh neonatal cadaveric sample. The primary aim was to determine the spread of the dye within the fascial plane, while the secondary aims were to determine whether the needle direction or entry site affected the spread.
The block was replicated bilaterally using 0.1 mL/kg of iodinated contrast dye in nine fresh unembalmed preterm neonatal cadavers. The dye was introduced under ultrasound guidance at vertebral level T5 and T8. Additionally, the needle was oriented cranial-caudal vs caudal-cranial to determine if the needle orientation influenced the spread of dye. The block was also replicated midway between the adjacent transverse processes as opposed to the lateral tip of the transverse process to determine the spread.
From the total sample size, 14 "blocks" were successfully replicated, while 4 "blocks" were either incomplete or failed blocks. Contrast dye was found in the paravertebral, intercostal, and epidural spaces, including posteriorly over the neural foramina. Results revealed that the needle direction or entry site did not influence the spread within the fascial plane.
Contrast material was found in the paravertebral, epidural, and intercostal spaces over an average of 5 vertebral levels when using 0.1 mL/kg.
自从竖脊肌平面阻滞出现以来，其已成功应用于成人和儿童的各种躯干手术。然而，在儿科人群中，其解剖结构特征、扩散途径和皮节覆盖范围仍不完全清楚。
通过在新鲜的新生儿尸体标本中复制竖脊肌平面阻滞，来确定竖脊肌筋膜平面空间的解剖特征。主要目的是确定在筋膜平面内染料的扩散情况，次要目的是确定针的方向或进入部位是否会影响扩散。
在 9 个未防腐的早产新生儿尸体标本中，使用 0.1 mL/kg 的碘对比染料双侧复制阻滞。在超声引导下，在 T5 和 T8 椎骨水平引入染料。此外，将针的方向设置为颅尾向或尾向颅，以确定针的方向是否影响染料的扩散。还在相邻横突的中间位置而不是横突的外侧尖端复制阻滞，以确定扩散情况。
在总共的样本量中，成功复制了 14 个“阻滞”，而 4 个“阻滞”要么不完全，要么失败。对比染料在椎旁、肋间和硬膜外间隙中发现，包括神经孔后面。结果表明，针的方向或进入部位并不影响筋膜平面内的扩散。
当使用 0.1 mL/kg 时，在平均 5 个椎体水平的椎旁、硬膜外和肋间空间中发现了对比材料。
