在上位肋横突韧带（retro-SCTL）间隙进行横突间阻滞（ITPB）：利用MRI评估健康志愿者局部麻醉药的扩散及感觉阻滞情况。

Intertransverse process block (ITPB) at the retro-superior costotransverse ligament (retro-SCTL) space: Evaluation of local anesthetic spread using MRI and sensory blockade in healthy volunteers.

作者信息

Pangthipampai Pawinee, Siriwanarangsun Palanan, Pakpirom Jatuporn, Sivakumar Ranjith Kumar, Karmakar Manoj Kumar

机构信息

Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

J Clin Anesth. 2025 Feb;101:111718. doi: 10.1016/j.jclinane.2024.111718. Epub 2024 Dec 18.

DOI:10.1016/j.jclinane.2024.111718

PMID:39700657

Abstract

BACKGROUND

This study evaluated the spread of a local anesthetic, using MRI and sensory blockade, after an intertransverse process block (ITPB) at the medial aspect of the retro-superior costotransverse ligament (retro-SCTL) space - the medial retro-SCTL space block.

METHODS

Ten healthy volunteers received a single-injection ultrasound-guided medial retro-SCTL space block at the T4-T5 level using a mixture of 10 ml 0.5 % bupivacaine with 0.5 ml gadolinium. At 15 min, they underwent a high resolution, fat suppressed, T1 weighted MRI scan of the cervicothoracic spine. Loss of sensation to cold was assessed at 15 and 60 min, and then hourly for 5-h, after the block.

RESULTS

MRI showed consistent (100 %) spread of local anesthetic to the intercostal and paravertebral spaces, anterolateral aspect of the vertebral body (sympathetic chain), costotransverse space, neural foramina, and epidural space in all participants. However, sensory blockade was variable across the ipsilateral hemithorax. Hypoesthesia was more common than anesthesia in both the anterior (median [IQR], 3.5 [2-5] vs 0 [0-1.25], p < 0.001) and posterior (median [IQR], 6[3-7] vs 2[1-3], p < 0.001) hemithorax. Additionally, more dermatomes exhibited anesthesia in the posterior compared to the anterior hemithorax (median [IQR], 2[1-3] vs 0[0-1.25], p = 0.01). A variable number of contralateral dermatomes were also affected in 3 (30 %) volunteers. There was no statistically significant correlation between the local anesthetic spread and the number of hypoesthetic (r = 0.53, p = 0.11) or anesthetic (r = 0.09, p = 0.78) dermatomes on the ipsilateral hemithorax.

CONCLUSIONS

A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.

摘要

背景

本研究采用磁共振成像（MRI）和感觉阻滞评估了在胸段后上肋横突韧带（retro-SCTL）内侧间隙（内侧retro-SCTL间隙阻滞）进行横突间阻滞（ITPB）后局部麻醉药的扩散情况。

方法

10名健康志愿者在T4-T5水平接受了单次注射超声引导下的内侧retro-SCTL间隙阻滞，使用10ml 0.5%布比卡因与0.5ml钆的混合液。15分钟后，他们接受了颈椎胸椎的高分辨率、脂肪抑制、T1加权MRI扫描。在阻滞15分钟和60分钟后，然后每小时评估一次，共评估5小时，评估冷觉丧失情况。

结果

MRI显示，所有参与者的局部麻醉药均一致（100%）扩散至肋间间隙和椎旁间隙、椎体前外侧（交感神经链）、肋横突间隙、神经孔和硬膜外间隙。然而，同侧半胸的感觉阻滞情况各不相同。在前侧半胸（中位数[四分位间距]，3.5[2-5]对0[0-1.25]，p<0.001）和后侧半胸（中位数[四分位间距]，6[3-7]对2[1-3]，p<0.001），感觉减退均比感觉缺失更为常见。此外，与前侧半胸相比，后侧半胸有更多的皮节出现感觉缺失（中位数[四分位间距]，2[1-3]对0[0-1.25]，p=0.01）。3名（30%）志愿者的对侧也有不同数量的皮节受到影响。同侧半胸局部麻醉药扩散与感觉减退（r=0.53，p=0.11）或感觉缺失（r=0.09，p=0.78）皮节数量之间无统计学显著相关性。