Cervical, Pain
Conditions
Keywords
Pain, Cervical, Spread
Brief summary
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
Detailed 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.
Interventions
PROCEDUREErector spinae plane block
fascial plane injection using ultrasound and fluoroscopic guidance
Sponsors
Keimyung University Dongsan Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| spread level in the cranio-caudal direction | baseline, 1 minutes after erector spinae plane block | fluoroscopic contrast medium spread level in the cranio-caudal direction |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participant showing epidural spread | baseline, 1 minute after erector spinae plane block | Number of participant showing epidural spread by analysis of fluoroscopic image |
| Number of participant showing intercostal spread | baseline, 1 minute after erector spinae plane block | Number of participant showing intercostal spread by analysis of fluoroscopic image |
| Number of participant showing paravertebral spread | baseline, 1 minute after erector spinae plane block | Number of participant showing paravertebral spread by analysis of fluorosocpic image |
| Number of participant showing intravascular spread | baseline, 1 minute after erector spinae plane block | Number of participants showing intravascular spread by analysis of fluoroscopic image |
Countries
South Korea
Outcome results
None listed