Sørenstua Marie, Zantalis Nikolaos, Raeder Johan, Vamnes Jan Sverre, Leonardsen Ann-Chatrin Linqvist
Department of Anesthesia, Sykehuset Østfold HF, Gralum, Norway
Faculty of Medicine, University of Oslo, Oslo, Norway.
Reg Anesth Pain Med. 2023 Feb;48(2):74-79. doi: 10.1136/rapm-2022-104012. Epub 2022 Nov 9.
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.
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.
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.
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.
NCT05012332.
竖脊肌平面阻滞（ESPB）是一种躯干筋膜阻滞，其作用机制和解剖部位存在争议。本研究旨在进行单侧ESPB，并使用磁共振成像（MRI）来研究局部麻醉药（LA）的扩散以及相应的针刺和冷觉感觉丧失情况。
10名志愿者在第七胸椎（Th7）水平接受了右侧ESPB，注射含钆布醇0.3 mL的2.5 mg/mL罗哌卡因30 mL。主要结局是在阻滞1小时后通过MRI评估LA的扩散情况。次要结局是在完成阻滞后30 - 50分钟时对冷觉和针刺觉的感觉丧失情况。
所有志愿者在MRI上均显示LA在竖脊肌内及向肋间间隙扩散。9/10扩散至椎旁间隙，8/10扩散至神经孔。4/10志愿者扩散至硬膜外间隙。1名志愿者硬膜外广泛扩散，同时对侧硬膜外和神经孔也有扩散。4名志愿者在腋中线前后均有感觉丧失，而6名志愿者仅在后侧有感觉丧失。
我们发现ESPB后LA持续扩散至肋间间隙、椎旁间隙和神经孔。4名志愿者出现硬膜外扩散。ESPB后30 - 50分钟的感觉测试结果差异很大，且通常未充分反映阻滞60分钟后MRI显示的扩散情况所预期的结果。
NCT05012332。
