后上肋横韧带（后sctl）间隙的横突间阻滞（ITPB）：用MRI和感觉阻滞评价健康志愿者局麻药的扩散。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-01 DOI:10.1016/j.jclinane.2024.111718

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

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引用次数: 0

摘要

背景：本研究评估了局部麻醉剂的扩散，使用MRI和感觉阻滞，在上肋横韧带后（后- sctl）间隙内侧进行横突间阻滞（ITPB）后-内侧后- sctl间隙阻滞。方法：10例健康志愿者在超声引导下，采用0.5%布比卡因10 ml加钆0.5 ml的混合物，在T4-T5水平进行内侧逆行sctl间隙阻滞。15分钟后，他们接受了高分辨率、脂肪抑制、T1加权的颈胸椎MRI扫描。在阻滞后的15和60分钟评估对寒冷的感觉丧失，然后每小时评估一次，持续5小时。结果：MRI显示局麻药在所有参与者的肋间和椎旁间隙、椎体前外侧（交感神经链）、肋横间隙、神经孔和硬膜外间隙的分布一致（100%）。然而，同侧半胸的感觉阻滞是不同的。结论：在T4-T5水平注射10.5 ml局麻药，单次注射内侧后sctl间隙阻滞，持续扩散到同侧肋间和椎旁间隙、交感神经链、肋横间隙、神经孔和硬膜外间隙，但产生同侧感觉阻滞，其变化性和后半胸比前半胸更宽。

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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

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.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.