竖脊肌平面阻滞术后局部麻醉药的扩散：一项随机、三维重建影像学研究。
Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study.
作者信息
Shan Tao, Zhang Xiaodan, Zhao Zhenyu, Zhou Xiao, Bao Hongguang, Su Chuan, Tan Qilian, Han Liu, Yin Jun
机构信息
Department of Anaesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Nuclear-Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
出版信息
Br J Anaesth. 2025 Mar;134(3):830-838. doi: 10.1016/j.bja.2024.10.046. Epub 2025 Jan 8.
BACKGROUND
Spread of local anaesthetic solution in the paravertebral space after erector spinae plane block (ESPB) is variable. We evaluated whether paravertebral spread of local anaesthetic is affected by patient position after ESPB.
METHODS
We randomised 84 patients to receive ESPB at T with a mixture of 0.375% ropivacaine and radiocontrast dye (30 ml). Participants were positioned supine, prone, or lateral for 30 min after ESPB before computed tomography scanning. The primary outcome was paravertebral space local anaesthetic spread, with secondary assessments of craniocaudal spread and distribution to neural foramina, and intercostal and epidural spaces. Loss of sensation to cold was recorded.
RESULTS
Local anaesthetic-contrast mix reached the paravertebral space, intercostal space, and neural foramina in 96.5%, 94.2%, and 77.9% of individuals, respectively. Epidural space spread occurred in 20 cases. Prone positioning consistently allowed paravertebral and intercostal spread in all patients, with more thoracic level spread compared with supine positioning (5.0 [1.9] vs 3.1 [1.7], difference [95% confidence interval, CI]: 1.9 [0.8-3.0] levels, P<0.001 for paravertebral space spread; 2.8 [1.9] vs 1.4 [1.4], difference [95% CI] levels: 1.4 [0.4-2.5], P=0.004 for neural foramina spread; 4.3 [1.3] vs 3.2 [1.5], difference [95% CI] levels: 1.0 [0.1-1.9], P=0.019 for intercostal space spread). Local anaesthetic-contrast extended to the intercostal space further in the prone than in the lateral position group (4.3 [1.3] vs 2.6 [1.5] thoracic levels, difference [95% CI]: 1.7 [0.8-2.6], P<0.001). Sensory block in ventral dermatomes was variable in all participants.
CONCLUSIONS
Prone positioning after ESPB significantly enhanced local anaesthetic-contrast spread to the paravertebral space, intercostal space, and neural foramina, suggesting that gravity plays a substantial role in spread.
CLINICAL TRIAL REGISTRATION
Clinical Trials.gov (NCT06142630).
背景
竖脊肌平面阻滞（ESPB）后局部麻醉药溶液在椎旁间隙的扩散情况不一。我们评估了ESPB后患者体位是否会影响局部麻醉药在椎旁间隙的扩散。
方法
我们将84例患者随机分为三组，在T节段接受0.375%罗哌卡因与放射性造影剂混合液（30 ml）的ESPB。ESPB后，参与者分别采取仰卧位、俯卧位或侧卧位30分钟，然后进行计算机断层扫描。主要结局指标是椎旁间隙局部麻醉药的扩散情况，次要评估指标包括头侧至尾侧的扩散、向椎间孔的分布以及向肋间间隙和硬膜外间隙的分布。记录冷觉丧失情况。
结果
局部麻醉药与造影剂混合液分别在96.5%、94.2%和77.9%的个体中到达椎旁间隙、肋间间隙和椎间孔。20例出现硬膜外间隙扩散。俯卧位能使所有患者的局部麻醉药持续扩散至椎旁间隙和肋间间隙，与仰卧位相比，胸段扩散范围更广（椎旁间隙扩散：5.0 [1.9] 节段 vs 3.1 [1.7] 节段，差异 [95% 置信区间，CI]：1.9 [0.8 - 3.0] 节段，P<0.001；椎间孔扩散：2.8 [1.9] 节段 vs 1.4 [1.4] 节段，差异 [95% CI]：1.4 [0.4 - 2.5] 节段，P = 0.004；肋间间隙扩散：4.3 [1.3] 节段 vs 3.2 [1.5] 节段，差异 [95% CI]：1.0 [0.1 - 1.9] 节段，P = 0.019）。与侧卧位组相比，局部麻醉药与造影剂混合液在俯卧位时向肋间间隙的扩散更远（胸段节段数：4.3 [1.3] 节段 vs 2.6 [1.5] 节段，差异 [95% CI]：1.7 [0.8 - 2.6] 节段，P<0.001）。所有参与者腹侧皮节的感觉阻滞情况各不相同。
结论
ESPB后采取俯卧位可显著增强局部麻醉药与造影剂向椎旁间隙、肋间间隙和椎间孔的扩散，提示重力在扩散中起重要作用。
临床试验注册
ClinicalTrials.gov（NCT06142630）
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