Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China.
Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China.
Pain Physician. 2023 Jul;26(4):E383-E387.
Anesthetic spread of ultrasound-guided paraspinal blocks is still unknown.
To compare the drug diffusion qualities of intertransverse process block (ITPB) and erector spinae plane block (ESPB) in clinical practice.
Prospective computed tomography (CT)-3-dimensional (3D) reconstruction image study.
Operation room in hospital.
Twenty patients undergoing thoracoscopic pulmonary wedge resection or segmentectomy were enrolled. These procedures require localization of pulmonary nodules using CT-guided needle puncture immediately before surgery. The patients were divided into 2 groups, each consisting of 10 patients. Group I underwent ITPB, while group E underwent ESPB. These interventions were performed 30 minutes before surgery using 20 mL of 0.25% bupivacaine with 2 mL iohexol. Sensory loss of the thoracic dermatomes was assessed using cold stimulation before general anesthesia. Patients' CT localization images were used for 3D reconstruction after surgery, and the diffusion of the drug in each cross-section of the CT images was evaluated.
Three-dimensional imaging of the drug showed that in group E, drug diffusion was improved in the cephalocaudal area compared to group I (10 vs 4.5 segments). Drug diffusion in group I was improved anteriorly and laterally ([10/10, 100%] in the paravertebral and intercostal spaces) and reached the front of the vertebral body along the thoracic fascia in certain segments (6/10, 60%). In group E, very few segments of the drug reached the paravertebral (2/10, 20%) and intercostal (3/10, 30%) spaces. All patients in group I had clear signs of loss of cold sensation on the lateral and anterior chest walls, with an average of 4 thoracic dermatomes. In group E, 3 patients had definite lateral and anterior chest wall cold stimulation signs, the thoracic dermatome was discontinuous, and the effect was only present between 1-2 segments. The blocking effect of the paraspinal zone was excellent (100%) in both groups.
However, this study has some limitations. First, the sample size was small, and clinical trials with larger samples are required to further verify the effects of ITPB and ESPB. Second, the same local anesthetic drug concentration and volume were used for both techniques in this study, and the effect of volume or concentration on drug diffusion was not further explored.
Compared with ESPB, ITPB yielded increased stability in lateral and anterior chest wall block with improved anterior and intercostal spread, but reduced cephalocaudal spread.
超声引导下椎旁间隙阻滞的麻醉扩散仍不清楚。
比较临床中经横突间（ITPB）和竖脊肌平面（ESPB）阻滞的药物扩散质量。
前瞻性 CT-三维（3D）重建图像研究。
医院手术室。
纳入 20 例行胸腔镜下肺楔形切除术或肺段切除术的患者。这些手术需要在术前使用 CT 引导下的针穿刺定位肺结节。患者分为 2 组，每组 10 例。组 I 行 ITPB，组 E 行 ESPB。在手术前 30 分钟，每组使用 20ml0.25%布比卡因和 2ml 碘海醇进行干预。全身麻醉前，使用冷刺激评估胸皮节段的感觉丧失情况。术后，使用患者 CT 定位图像进行 3D 重建，并评估 CT 图像每个横截面上药物的扩散情况。
药物的 3D 成像显示，与组 I 相比，组 E 的药物扩散在头侧-尾侧方向上得到改善（10 个 vs 4.5 个节段）。组 I 的药物扩散在前部和外侧部得到改善（椎旁和肋间间隙为 10/10，100%），并在某些节段沿着胸筋膜到达椎体前部（6/10，60%）。在组 E 中，只有少数药物到达椎旁（2/10，20%）和肋间（3/10，30%）间隙。组 I 的所有患者在前胸侧壁的外侧和前侧均有明显的冷感丧失迹象，平均有 4 个胸皮节段。在组 E 中，3 例患者在前胸侧壁有明确的冷刺激迹象，胸皮节段不连续，效果仅存在于 1-2 个节段之间。两组的脊柱旁阻滞效果均为 100%（极佳）。
然而，本研究存在一些局限性。首先，样本量较小，需要进行更大样本量的临床试验以进一步验证 ITPB 和 ESPB 的效果。其次，本研究中两种技术均使用相同的局部麻醉药物浓度和容量，未进一步探讨容量或浓度对药物扩散的影响。
与 ESPB 相比，ITPB 在前胸侧壁阻滞中产生了更稳定的阻滞效果，改善了前侧和肋间的扩散，但减少了头侧-尾侧的扩散。
