Wang Chao-Wei, Zou Ping, Zhang Zu-Xiong, Si Mao-Yan, Yi Qin-Guo, Zhan Li-Fang
The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi Province, China.
Department of Anesthesiology, Shishi General Hospital, Quanzhou, Fujian Province, China.
BMC Anesthesiol. 2025 Apr 5;25(1):155. doi: 10.1186/s12871-025-03017-x.
Intertransverse process (ITP) blocks showed reliable paravertebral spread in cadaveric studies, but specific distribution patterns, spread pathways, and dose‒effect relationships remain unclear. The aim of this study was to evaluate the distribution patterns of three different volumes of local anesthetic (LA) in ITP block in living humans using computed tomography.
Forty-five individuals (18-75 years old) were randomized to receive 0.375% ropivacaine with radiopaque contrast agent at doses of 0.3, 0.4, or 0.5 ml/kg. The primary outcome was the distribution of LA in mediastinal compartments (prevascular, visceral, and paravertebral), retro-superior costotransverse ligament space, erector spinae fascia plane, intercostal space, sympathetic ganglion, costotransverse space, intervertebral foramen, lateral recess, and epidural space. The secondary outcomes included intraoperative and postoperative VAS scores, dermatomal sensory loss, block-related adverse events, and the time required for block administration.
The spread pattern of local anesthetic after intertransverse process block includes both forward and backward spread. The LA was concentrated in the visceral compartment (77.5%), paravertebral compartment (93.3%), erector spinae fascia plane (97.8%), intercostal space (97.8%), and sympathetic ganglion (88.9%), with occasional spread to other areas. The overall distribution pattern was significantly influenced by patient position (R = 0.07, F. Model = 3.43, P = 0.04) rather than anesthetic volume (R = 0.03, F. Model = 1.60, P = 0.20) and BMI category (R = 0.03, F. Model = 1.36, P = 0.26). The LA was concentrated in the prevascular compartment when the patient position was changed in the prone position (B = 2.45, 95% CI [0.96, 3.95], P = 0.002). There were no differences in secondary outcomes.
ITP block causes the LA to predominantly spread to the paravertebral compartment, visceral compartment, intercostal space, sympathetic ganglion, and erector spinae fascia plane. Within the range of volumes studied (0.3, 0.4, and 0.5 ml/kg), increasing the LA volume did not result in a wider distribution range; the overall distribution pattern was primarily influenced by patient positioning.
The trial was registered online on 3 April 2024 in the Chinese Clinical Trial Registry (ChiCTR2400082665).
在尸体研究中，横突间阻滞（ITP）显示出可靠的椎旁扩散，但具体的分布模式、扩散途径和剂量-效应关系仍不清楚。本研究的目的是使用计算机断层扫描评估在活体人类中进行ITP阻滞时三种不同体积的局部麻醉药（LA）的分布模式。
45名年龄在18至75岁之间的个体被随机分配接受含不透射线造影剂的0.375%罗哌卡因，剂量为0.3、0.4或0.5 ml/kg。主要结局是LA在纵隔间隙（血管前、内脏和椎旁）、后上肋横突韧带间隙、竖脊肌筋膜平面、肋间间隙、交感神经节、肋横突间隙、椎间孔、侧隐窝和硬膜外间隙的分布。次要结局包括术中及术后视觉模拟评分（VAS）、皮节感觉丧失、阻滞相关不良事件以及阻滞给药所需时间。
横突间阻滞后局部麻醉药的扩散模式包括向前和向后扩散。LA主要集中在内脏间隙（77.5%）、椎旁间隙（93.3%）、竖脊肌筋膜平面（97.8%）、肋间间隙（97.8%）和交感神经节（88.9%），偶尔扩散到其他区域。总体分布模式受患者体位的显著影响（R = 0.07，F模型 = 3.43，P = 0.04），而非麻醉药体积（R = 0.03，F模型 = 1.60，P = 0.20）和BMI类别（R = 0.03，F模型 = 1.36，P = 0.26）。当患者体位改为俯卧位时，LA集中在血管前间隙（B = 2.45，95%可信区间[0.96，3.95]，P = 0.002）。次要结局无差异。
ITP阻滞使LA主要扩散到椎旁间隙、内脏间隙、肋间间隙、交感神经节和竖脊肌筋膜平面。在所研究的体积范围内（0.3、0.4和0.5 ml/kg），增加LA体积并未导致更广泛的分布范围；总体分布模式主要受患者体位影响。
该试验于2024年4月3日在中国临床试验注册中心在线注册（ChiCTR2400082665）。
