Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2025-01-08 DOI:10.1016/j.bja.2024.10.046

Tao Shan, Xiaodan Zhang, Zhenyu Zhao, Xiao Zhou, Hongguang Bao, Chuan Su, Qilian Tan, Liu Han, Jun Yin

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引用次数: 0

Abstract

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 T₇ 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).

查看原文本刊更多论文

竖脊肌平面阻滞后局部麻醉的扩散：一项随机、三维重建、成像研究。

背景：竖脊肌平面阻滞（ESPB）后椎旁间隙局麻溶液的分布是可变的。我们评估ESPB后椎旁局部麻醉的扩散是否受患者体位的影响。方法：我们随机选择84例患者在T7时接受ESPB，其中含有0.375%罗哌卡因和放射线造影剂（30 ml）的混合物。ESPB后，在计算机断层扫描前，参与者被置于仰卧位、俯卧位或侧卧位30分钟。主要结果是椎旁间隙局部麻醉的扩散，其次评估颅侧的扩散和分布到神经孔、肋间和硬膜外间隙。记录了对寒冷失去知觉的情况。结果：局麻-造影剂混合物到达椎旁间隙、肋间隙和神经孔的比例分别为96.5%、94.2%和77.9%。硬膜外腔扩散20例。俯卧位在所有患者中均允许椎旁和肋间扩散，与仰卧位相比，胸椎水平扩散更多(5.0 [1.9]vs 3.1[1.7]，差异[95%置信区间，CI]: 1.9[0.8-3.0]水平。结论：ESPB术后俯卧位可显著增强局部麻醉-造影剂向椎旁间隙、肋间间隙和神经孔的扩散，提示重力在扩散中起重要作用。临床试验注册：Clinical Trials.gov （NCT06142630）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.