Regional Anesthesia & Pain Medicine,
Journal Year:
2023,
Volume and Issue:
49(3), P. 223 - 226
Published: Sept. 19, 2023
Since
its
description
in
2016,
the
erector
spinae
plane
block
(ESPB)
has
become
a
widely
employed
regional
anesthetic
technique
and
kindled
interest
range
of
related
techniques,
collectively
termed
intertransverse
process
blocks.
There
been
ongoing
controversy
over
mechanism
action
ESPB,
mainly
due
to
incongruities
between
results
cutaneous
sensory
testing,
clinical
efficacy
studies,
investigations
into
neural
structures
that
are
reached
by
injected
local
(LA).
This
paper
reviews
spread
LA
paravertebral
epidural
space
anesthesia
with
specific
emphasis
on
dorsal
root
ganglion
(DRG).
We
hypothesize
DRG,
unique
complex
microarchitecture,
represents
key
therapeutic
target
for
modulation
nociceptive
signaling
anesthesia.
discusses
how
anatomical
physiological
characteristics
DRG
may
be
one
factors
underpinning
analgesia
observed
ESPB
other
Regional Anesthesia & Pain Medicine,
Journal Year:
2021,
Volume and Issue:
46(7), P. 618 - 628
Published: June 18, 2021
Background
Fascial
plane
blocks
(FPBs)
target
the
space
between
two
fasciae,
rather
than
discrete
peripheral
nerves.
Despite
their
popularity,
mechanisms
of
action
remain
controversial,
particularly
for
erector
spinae
and
quadratus
lumborum
blocks.
Objectives
This
narrative
review
describes
scientific
evidence
underpinning
proposed
action,
highlights
existing
knowledge
gaps,
discusses
implications
clinical
practice
research.
Findings
There
are
currently
plausible
analgesia.
The
first
is
a
local
effect
on
nociceptors
neurons
within
itself
or
adjacent
muscle
tissue
compartments.
Dispersion
anesthetic
occurs
through
bulk
flow
diffusion,
resulting
conduction
block
dictated
by
mass
reaching
these
targets.
extent
spread,
analgesia,
cutaneous
sensory
loss
variable
imperfectly
correlated.
Explanations
include
anatomical
variation,
factors
governing
fluid
dispersion,
pharmacodynamics.
second
vascular
absorption
systemic
analgesic
at
distant
sites.
Direct
presently
lacking
but
preliminary
data
indicate
that
FPBs
can
produce
transient
elevations
in
plasma
concentrations
similar
to
intravenous
lidocaine
infusion.
relative
contributions
effects
uncertain.
Conclusion
Our
current
understanding
FPB
supports
demonstrated
efficacy,
also
unpredictability
variability
result
from
myriad
play.
Potential
strategies
improve
efficacy
accurate
deposition
close
targets
interest,
injections
sufficient
volume
encourage
physical
spread
flow,
manipulation
concentration
promote
diffusion.
British Journal of Anaesthesia,
Journal Year:
2025,
Volume and Issue:
unknown
Published: Jan. 1, 2025
Spread
of
local
anaesthetic
solution
in
the
paravertebral
space
after
erector
spinae
plane
block
(ESPB)
is
variable.
We
evaluated
whether
spread
affected
by
patient
position
ESPB.
randomised
84
patients
to
receive
ESPB
at
T
Local
anaesthetic-contrast
mix
reached
space,
intercostal
and
neural
foramina
96.5%,
94.2%,
77.9%
individuals,
respectively.
Epidural
occurred
20
cases.
Prone
positioning
consistently
allowed
all
patients,
with
more
thoracic
level
compared
supine
(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
spread;
2.8
1.4
[1.4],
CI]
levels:
[0.4-2.5],
P=0.004
4.3
[1.3]
3.2
[1.5],
1.0
[0.1-1.9],
P=0.019
spread).
extended
further
prone
than
lateral
group
(4.3
2.6
[1.5]
1.7
[0.8-2.6],
P<0.001).
Sensory
ventral
dermatomes
was
variable
participants.
significantly
enhanced
foramina,
suggesting
that
gravity
plays
a
substantial
role
spread.
Clinical
Trials.gov
(NCT06142630).
Journal of Pain Research,
Journal Year:
2025,
Volume and Issue:
Volume 18, P. 489 - 496
Published: Jan. 1, 2025
Pectus
excavatum
repair
using
the
Nuss
procedure
is
associated
with
significant
postoperative
opioid
consumption
even
in
presence
of
a
continuous
thoracic
paravertebral
block.
A
CQI
project
was
initiated
by
adding
combined
glucocorticoids
as
perineural
adjuvants
to
An
electronic
health
record
review
patients
undergoing
procedures
single
surgeon
at
major
academic
children's
hospital
from
June
2013
December
2021
performed
no
excluded.
The
received
pre-incision
bilateral
T4
blocks
preoperatively
either
plain
ropivacaine
(standard
group,
N
=
34)
or
combination
dexamethasone
sodium
phosphate
(DXP)
and
methylprednisolone
acetate
(MPA)
addition
(experimental
10).
primary
outcome
studied
measured
oral
morphine
milligram
equivalents
(MME).
total
44
were
included
final
analysis.
experimental
group
had
72%
lower
usage
than
standard
during
hospitalization
(p
<
0.001)
comparable
pain
scores
length
stay
increase
wound
dehiscence
other
complications.
significantly
decreased
while
maintaining
comfort
scores.
Regional Anesthesia & Pain Medicine,
Journal Year:
2022,
Volume and Issue:
48(2), P. 74 - 79
Published: Nov. 9, 2022
Background
Erector
spinae
plane
block
(ESPB)
is
a
truncal
fascial
with
disputed
mechanism
and
anatomical
site
of
effect.
This
study
aimed
to
perform
one-sided
ESPB
use
MRI
investigate
the
spread
local
anesthetic
(LA)
corresponding
cutaneous
loss
sensation
pinprick
cold.
Methods
Ten
volunteers
received
right-sided
at
level
seventh
thoracic
vertebra
(Th7),
consisting
30
mL
2.5
mg/mL
ropivacaine
0.3
gadolinium.
The
primary
outcome
was
evaluation
LA
on
1-hour
postblock.
secondary
cold
30–50
min
after
performed.
Results
All
had
in
erector
muscles
intercostal
space.
9/10
paravertebral
space
8/10
neural
foramina.
4/10
epidural
One
volunteer
extensive
as
well
contralateral
foraminal
spread.
Four
both
posterior
anterior
midaxillary
line,
while
six
only
side.
Conclusion
We
found
that
consistently
spreads
space,
foramina
an
ESPB.
Epidural
evident
four
volunteers.
Sensory
testing
shows
highly
variable
results,
generally
under-represents
what
could
be
expected
from
visualized
60
performance.
Trial
registration
number
NCT05012332
.
