A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade
A Cadaveric Study Investigating the Mechanism of Action of Erector Spinae Blockade
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DOI：
10.1097/aap.0000000000000789
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发表时间：
2018-08-01
影响因子：
5.1
通讯作者：
Barrington, Michael J.
中科院分区：
文献类型：
--
作者：
Ivanusic, Jason;Konishi, Yasutaka;Barrington, Michael J.
背景和目的竖脊肌阻滞是2016年首次描述的超声引导筋膜间平面阻滞。本尸体染料注射和解剖研究的目的是模拟竖脊肌阻滞，以确定染料是否会向前蔓延到涉及的腹侧和背侧支的脊神经nerves.Methods在10个unembalmed人尸体，20毫升的0.25%亚甲蓝染料注入到第五胸横突和竖脊肌之间的平面两侧。使用了一种平面内超声引导技术，其中换能器纵向定向。在解剖过程中，确定了浅表和深部肌肉，并记录了头尾向和侧向的染料扩散程度。结果染料在竖脊肌的深、浅部有广泛的头尾向和侧向扩散，在竖脊肌的深、浅部有广泛的头尾向和侧向扩散，在竖脊肌的深、浅部有广泛的染色。除1次注射（来自20次）外，腹侧支未被染料染色。仅在2次注射中，染料通过肋横突孔向后追踪至背根神经节。在所有其他情况下，背根神经节不参与染料注射。染料染色后支肋横突孔。结论有没有染料向前蔓延到椎旁间隙涉及的腹侧和背侧支的起源胸脊神经。背支受累位于肋横突孔后方。
Background and Objectives Erector spinae block is an ultrasound-guided interfascial plane block first described in 2016. The objectives of this cadaveric dye injection and dissection study were to simulate an erector spinae block to determine if dye would spread anteriorly to the involve origins of the ventral and dorsal branches of the spinal nerves.Methods In 10 unembalmed human cadavers, 20 mL of 0.25% methylene blue dye was injected bilaterally into the plane between the fifth thoracic transverse process and erector spinae muscle. An in-plane ultrasound-guided technique with the transducer orientated longitudinally was used. During dissection, superficial and deep muscles were identified, and extent of dye spread was documented in cephalocaudal and lateral directions. The ventral and dorsal rami of spinal nerves and dorsal root ganglion at each level were examined to determine if they were stained by dye.Results There was extensive cephalocaudad and lateral spread of dye deep and superficial to the erector spinae muscles. Except for 1 injection (from 20), the ventral rami were not stained by the dye. In only 2 injections did the dye track posteriorly through the costotransverse foramen to the dorsal root ganglion. In all other cases, the dorsal root ganglia were not involved in the dye injection. The dye stained the dorsal rami posterior to the costotransverse foramen.Conclusions There was no spread of dye anteriorly to the paravertebral space to involve origins of the ventral and dorsal branches of the thoracic spinal nerves. Dorsal ramus involvement was posterior to the costotransverse foramen.