Harbell Monica, Nelson James A, Langley Natalie R, Seamans David P, Craner Ryan
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Reg Anesth Pain Med. 2024 Aug 21. doi: 10.1136/rapm-2024-105818.
Few cadaveric studies have evaluated the dye spread with superficial parasternal intercostal plane (SPIP) blocks. In this study, we examined the dye spread of an ultrasound-guided SPIP block in a human cadaveric model with single and double injection techniques.
Seven single and four double ultrasound-guided SPIP blocks were performed in seven unembalmed human cadavers using an in-plane approach with the transducer oriented parasagitally 1 cm lateral to the sternum. For the single SPIP, 20 mL of 0.166% methylene blue was injected in the second or third intercostal space into the plane between the Pec major muscle and internal intercostal muscles. For the double SPIP, 10 mL of 0.166% methylene blue was injected in the SPIP at one intercostal space with an additional 10 mL injected in the SPIP two intercostal spaces caudally. The extent of dye spread was documented.
For all SPIP injections, there was consistent mediolateral spread from the sternum to the mid-clavicular line, with many extending laterally to the anterior axillary line. There was craniocaudal spread to a median of 2 intercostal muscles with a single SPIP and 3 intercostal muscles with a double SPIP. There was a median spread to 1 intercostal nerve for the single SPIP and 1.5 intercostal nerves with the double SPIP.
The SPIP block demonstrated limited spread in this cadaver study. A single injection of this block may be of limited value and multiple SPIP injections may be needed to have adequate spread for anterior thoracic procedures.
很少有尸体研究评估胸骨旁浅肋间平面（SPIP）阻滞时染料的扩散情况。在本研究中，我们在人体尸体模型中采用单注射和双注射技术，研究了超声引导下SPIP阻滞时染料的扩散情况。
在7具未防腐处理的人体尸体上进行了7次单超声引导下SPIP阻滞和4次双超声引导下SPIP阻滞，采用平面内进针法，将探头置于胸骨旁1 cm矢状旁位。对于单次SPIP阻滞，将20 mL 0.166%的亚甲蓝注入第二或第三肋间间隙，注入胸大肌和肋间内肌之间的平面。对于双次SPIP阻滞，在一个肋间间隙的SPIP中注入10 mL 0.166%的亚甲蓝，并在其下方两个肋间间隙的SPIP中额外注入10 mL。记录染料扩散的范围。
对于所有SPIP注射，染料从胸骨向锁骨中线呈一致的内外侧扩散，许多扩散至腋前线外侧。单次SPIP阻滞时，染料向头尾方向扩散至中位数为2个肋间肌，双次SPIP阻滞时为3个肋间肌。单次SPIP阻滞时，染料扩散至中位数为1条肋间神经，双次SPIP阻滞时为1.5条肋间神经。
在本尸体研究中，SPIP阻滞显示出有限的扩散。单次注射该阻滞可能价值有限，对于前胸手术可能需要多次SPIP注射以获得足够的扩散范围。
