Background and Aims Erector Spinae Plane Block (ESPB) is a truncal fascial block with a disputed mechanism and anatomical site of effect. This study aimed to perform a one-sided ESPB and utilize magnetic resonance imaging (MRI) to investigate the spread of the local anesthetic (LA) and the corresponding dermatomal loss of sensation to pinprick and cold.
Methods Ten volunteers received a right-sided ESPB at the level of Th7, consisting of 30 ml 2,5 mg/ml ropivacaine with 0,3 ml gadolinium. The loss of sensation to cold and pinprick was registered 30 minutes after the block was performed. One-hour post block an MRI was performed.
Results All volunteers had a spread of LA on MRI in the erector spinae muscles and to the intercostal space. 9/10 had spread to the paravertebral space and 8/10 had spread to the neural foramina. 4/10 volunteers had spread to the epidural space. One volunteer had extensive epidural spread as well as contralateral epidural spread. Four volunteers had a loss of sensation both posterior and anterior to the midaxillary line, while six volunteers had loss of sensation only on the posterior side.
Conclusions We found that LA consistently spreads to the intercostal space, the paravertebral space and the neural foramina after an ESPB. Epidural spread was evident in 4 volunteers. Sensibility testing after an ESPB is variable and does not consistently reflect the visualized spread on MRI.
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