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Published in: BMC Anesthesiology 1/2020

Open Access 01-12-2020 | Ultrasound | Research article

The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study

Authors: Jingxiong Zhang, Yuting He, Shi Wang, Zhengjie Chen, Yu Zhang, Yuan Gao, Quanguang Wang, Yun Xia, Thomas J. Papadimos, Riyong Zhou

Published in: BMC Anesthesiology | Issue 1/2020

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Abstract

Background

Ultrasound-guided erector spine plane (ESP) block is widely used in perioperative analgesia for back, chest and abdominal surgery. The extent and distribution of this block remain controversial. This study was performed to assess the analgesia range of an ultrasound-guided ESP block.

Methods

This prospective observational volunteer study consisted of 12 healthy volunteers. All volunteers received an erector spinae plane block at the left T5 transverse process using real-time ultrasound guidance. Measured the cutaneous sensory loss area (CSLA) and cutaneous sensory declination area (CSDA) using cold stimulation at different time points after blockade until its disappearance. The CSLA and CSDA were mapped and then calculated. The block range was described by spinous process level and lateral extension. The effective block duration for each volunteer was determined and recorded.

Results

The cold sensory loss concentrates at T6-T9. The decline concentrates primarily at T4-T11. The lateral diffusion of block to the left side did not cross the posterior axillary line, and reached the posterior median line on the right. The area of cutaneous sensory loss was (172 ± 57) cm2, and the area of cutaneous sensory decline was (414 ± 143) cm2. The duration of cutaneous sensory decline was (586 ± 28) minutes.

Conclusion

Ultrasound-guided erector spine plane block with 20 mL of 0. 5% ropivacaine provided a widespread cutaneous sensory block in the posterior thorax, but did not reach the anterior chest, lateral chest, or abdominal walls. The range of the blockade suggested that the dorsal branch of spinal nerve was blocked.

Trial registration

Chinese Clinical Trial Registry, CHiCTR1800014438​. Registered 13 January 2018
Literature
1.
go back to reference Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector Spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.CrossRef Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector Spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.CrossRef
2.
go back to reference Forero M, Rajarathinam M, Adhikary S, Chin KJ. Continuous erector Spinae plane block for rescue analgesia in thoracotomy after epidural failure: a case report. A A Case Rep. 2017;8(10):254–6.CrossRef Forero M, Rajarathinam M, Adhikary S, Chin KJ. Continuous erector Spinae plane block for rescue analgesia in thoracotomy after epidural failure: a case report. A A Case Rep. 2017;8(10):254–6.CrossRef
3.
go back to reference Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med. 2019;7(8):174.CrossRef Fang B, Wang Z, Huang X. Ultrasound-guided preoperative single-dose erector spinae plane block provides comparable analgesia to thoracic paravertebral block following thoracotomy: a single center randomized controlled double-blind study. Ann Transl Med. 2019;7(8):174.CrossRef
4.
go back to reference Chin KJ, Malhas L, Perlas A. The erector Spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–6.CrossRef Chin KJ, Malhas L, Perlas A. The erector Spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med. 2017;42(3):372–6.CrossRef
5.
go back to reference Ueshima H, Otake H. Clinical experiences of ultrasound-guided erector spinae plane block for thoracic vertebra surgery. J Clin Anesth. 2017;38:137.CrossRef Ueshima H, Otake H. Clinical experiences of ultrasound-guided erector spinae plane block for thoracic vertebra surgery. J Clin Anesth. 2017;38:137.CrossRef
6.
go back to reference Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101–6.CrossRef Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: a prospective, randomized, controlled clinical trial. J Clin Anesth. 2018;49:101–6.CrossRef
7.
go back to reference Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Clin Anesth. 2019;59:106–11.CrossRef Chen N, Qiao Q, Chen R, Xu Q, Zhang Y, Tian Y. The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial. J Clin Anesth. 2019;59:106–11.CrossRef
8.
go back to reference Altiparmak B, Korkmaz Toker M, Uysal AI, Gumus Demirbilek S. Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019;19(1):31.CrossRef Altiparmak B, Korkmaz Toker M, Uysal AI, Gumus Demirbilek S. Comparison of the efficacy of erector spinae plane block performed with different concentrations of bupivacaine on postoperative analgesia after mastectomy surgery: ramdomized, prospective, double blinded trial. BMC Anesthesiol. 2019;19(1):31.CrossRef
9.
go back to reference Gaweda B, Borys M, Belina B, Bak J, Czuczwar M, Woloszczuk-Gebicka B, Kolowca M, Widenka K. Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial. BMC Anesthesiol. 2020;20(1):51.CrossRef Gaweda B, Borys M, Belina B, Bak J, Czuczwar M, Woloszczuk-Gebicka B, Kolowca M, Widenka K. Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial. BMC Anesthesiol. 2020;20(1):51.CrossRef
10.
go back to reference Oksuz G, Bilgen F, Arslan M, Duman Y, Urfalioglu A, Bilal B. Ultrasound-guided bilateral erector Spinae block versus tumescent anesthesia for postoperative analgesia in patients undergoing reduction mammoplasty: a randomized controlled study. Aesthet Plast Surg. 2019;43(2):291–6.CrossRef Oksuz G, Bilgen F, Arslan M, Duman Y, Urfalioglu A, Bilal B. Ultrasound-guided bilateral erector Spinae block versus tumescent anesthesia for postoperative analgesia in patients undergoing reduction mammoplasty: a randomized controlled study. Aesthet Plast Surg. 2019;43(2):291–6.CrossRef
11.
go back to reference Abu Elyazed MM, Mostafa SF, Abdelghany MS, Eid GM. Ultrasound-guided erector Spinae plane block in patients undergoing open Epigastric hernia repair: a prospective randomized controlled study. Anesth Analg. 2019;129(1):235–40.CrossRef Abu Elyazed MM, Mostafa SF, Abdelghany MS, Eid GM. Ultrasound-guided erector Spinae plane block in patients undergoing open Epigastric hernia repair: a prospective randomized controlled study. Anesth Analg. 2019;129(1):235–40.CrossRef
12.
go back to reference Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth. 2019;66(8):886–93.CrossRef Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth. 2019;66(8):886–93.CrossRef
13.
go back to reference Cosarcan SK, Dogan AT, Ercelen O, Gurkan Y. Superior costotransverse ligament is the main actor in permeability between the layers? Target-specific modification of erector spinae plane block. Reg Anesth Pain Med 2019. Cosarcan SK, Dogan AT, Ercelen O, Gurkan Y. Superior costotransverse ligament is the main actor in permeability between the layers? Target-specific modification of erector spinae plane block. Reg Anesth Pain Med 2019.
14.
go back to reference Tulgar S, Ahiskalioglu A, Thomas DT, Gurkan Y. Should erector spinae plane block applications be standardized or should we revise nomenclature? Reg Anesth Pain Med. 2020;45(4):318–19. Tulgar S, Ahiskalioglu A, Thomas DT, Gurkan Y. Should erector spinae plane block applications be standardized or should we revise nomenclature? Reg Anesth Pain Med. 2020;45(4):318–19.
15.
go back to reference Ueshima H, Otake H. Limitations of the erector Spinae plane (ESP) block for radical mastectomy. J Clin Anesth. 2018;51:97.CrossRef Ueshima H, Otake H. Limitations of the erector Spinae plane (ESP) block for radical mastectomy. J Clin Anesth. 2018;51:97.CrossRef
16.
go back to reference Drennen A. Erector spinae block to reduce pain after reduction mammoplasty: we need more evidence. Aesthetic Plast Surg. 2019;43(5):1406–7. Drennen A. Erector spinae block to reduce pain after reduction mammoplasty: we need more evidence. Aesthetic Plast Surg. 2019;43(5):1406–7.
17.
go back to reference Taketa Y, Irisawa Y, Fujitani T. Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax. J Clin Anesth. 2018;47:84–5.CrossRef Taketa Y, Irisawa Y, Fujitani T. Ultrasound-guided erector spinae plane block elicits sensory loss around the lateral, but not the parasternal, portion of the thorax. J Clin Anesth. 2018;47:84–5.CrossRef
18.
go back to reference Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector Spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. A A Case Rep. 2017;9(11):319–21.CrossRef Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector Spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. A A Case Rep. 2017;9(11):319–21.CrossRef
19.
go back to reference Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452–60.CrossRef Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452–60.CrossRef
20.
go back to reference Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Can J Anaesth. 2018;65(10):1165–6.CrossRef Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Can J Anaesth. 2018;65(10):1165–6.CrossRef
21.
go back to reference Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: a case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Ind J Anaesth. 2018;62(1):75–8.CrossRef Adhikary SD, Pruett A, Forero M, Thiruvenkatarajan V. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: a case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Ind J Anaesth. 2018;62(1):75–8.CrossRef
22.
go back to reference Vidal E, Giménez H, Forero M, Fajardo M. Erector spinae plane block: a cadaver study to determine its mechanism of action. Rev Esp Anestesiol Reanim. 2018;65(9):514–9.CrossRef Vidal E, Giménez H, Forero M, Fajardo M. Erector spinae plane block: a cadaver study to determine its mechanism of action. Rev Esp Anestesiol Reanim. 2018;65(9):514–9.CrossRef
23.
go back to reference Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73(10):1244–50.CrossRef Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018;73(10):1244–50.CrossRef
24.
go back to reference Otero PE, Fuensalida SE, Russo PC, Verdier N, Blanco C, Portela DA. Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model. Reg Anesth Pain Med. 2020;45(3):198–203. Otero PE, Fuensalida SE, Russo PC, Verdier N, Blanco C, Portela DA. Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model. Reg Anesth Pain Med. 2020;45(3):198–203.
25.
go back to reference Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector Spinae blockade. Reg Anesth Pain Med. 2018;43(6):567–71.CrossRef Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector Spinae blockade. Reg Anesth Pain Med. 2018;43(6):567–71.CrossRef
26.
go back to reference Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36.CrossRef Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36.CrossRef
27.
go back to reference Munoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. 2017;64(8):880–2.CrossRef Munoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. 2017;64(8):880–2.CrossRef
28.
go back to reference Evans HT, Leslie GJ, Rutka O, Keevil E, Burckett-St Laurent D. Bilateral erector Spinae plane block for surgery on the posterior aspect of the neck: a case report. A A Pract. 2019;12(10):356–8.CrossRef Evans HT, Leslie GJ, Rutka O, Keevil E, Burckett-St Laurent D. Bilateral erector Spinae plane block for surgery on the posterior aspect of the neck: a case report. A A Pract. 2019;12(10):356–8.CrossRef
Metadata
Title
The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study
Authors
Jingxiong Zhang
Yuting He
Shi Wang
Zhengjie Chen
Yu Zhang
Yuan Gao
Quanguang Wang
Yun Xia
Thomas J. Papadimos
Riyong Zhou
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-020-01002-0

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