Analysis of Spread Level During Thoracic Erector Spinae Block

Keimyung University

Status: Completed

Conditions: Radiculopathy, Cervical; Pain

Treatments: Procedure: Erector spinae plane block

Study type: Interventional

Funder types: Other

Identifiers

NCT05082220

Dongsan Hospital

Details and patient eligibility

About

The primary purpose of this study was to identify the ESPB spread level in the craniocaudal direction when performed at the T2 level. The secondary purpose was to determine the incidence of spread into epidural, paravertebral, intercostal, and intravascular injections with ESPB

Full description

The ESPB requires ultrasound guidance which enables visible local anesthetic spread underneath the erector spinae muscles. The spinalis, longissimus thoracis, and iliocostalis muscles comprise the ES muscles, which run vertically along both sides of the vertebral column from the sacrum up to the skull base. The ESPB can be performed in the cervical, thoracic, and lumbar regions. Among them, upper or mid thoracic ESPB has been used more widely compared to cervical and lumbar regions. Previous cadaveric studies on the ESPB at the T5 level using computed tomography (CT) reconstruction or direct dissection demonstrated the extensive craniocaudal distribution of methylene blue ranging from T1 to T8 vertebral segments deep to the ES muscles and variable involvement of epidural, paravertebral, and intercostal spaces. The ESPB performed at the T2 level of the cadaver demonstrated an injected dye distribution ranging from C4 to T10. Also, 36% of cadavers showed the spread of an injected dye to the ventral, dorsal ramus, paravertebral space, and even the contralateral side. The exact mechanism of action of ESPB remains unclear. A recent study suggested that the analgesic effect of ESPB could be obtained by blocking the ventral and dorsal ramus of the spinal nerves by passing through the costotransverse foramen. However, in clinical practice, we can encounter highly variable clinical outcomes or sensory block after the ESPB. The study of the physical spread of the injected agent can be used to predict the clinical result and elucidate the possible mechanism of action of ESPB.

Enrollment: 157 patients

Sex: All

Ages: 20 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• cervical facet joint arthrosis
• cervical foraminal stenosis
• cervical herniated intervertebral disc
• myofascial pain syndrome of upper back muscle

Exclusion criteria

• allergy to local anesthetics or contrast medium
• pregnancy
• prior history of cervical spine surgery
• coagulation abnormality

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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157 participants in 2 patient groups

10 ml ESPB group

Experimental group

Description:

ESPB group using 10 ml mixture of local anesthetics and contrast medium using ultrasound and fluoroscopy

Treatment:

Procedure: Erector spinae plane block

20 ml ESPB group

Experimental group

Description:

ESPB group using 20 ml mixture of local anesthetics and contrast medium using ultrasound and fluoroscopy

Treatment:

Procedure: Erector spinae plane block