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Abstract
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Background and Aims This study evaluated the spread of injectate and sensory blockade after an ultrasound-guided (USG) intertransverse process block (ITPB) at the retro superior costotransverse ligament (SCTL) space.
Methods After ethical approval and informed consent, 10 healthy volunteers received an USG ITPB at the retro-SCTL space (T4-T5 level), using a mixture of 10 ml 0.5% bupivacaine with 0.5 ml gadolinium. At 15 minutes, they underwent a T1-weighted MRI of the thorax. Loss of sensation to cold was assessed at 15 and 60 minutes, and then hourly until 5-hours, after the block. Physical spread of injectate on the MRI and loss of sensation to cold over the thorax were the primary and secondary outcomes, respectively.
Results The injectate spread to the ipsilateral paravertebral space, neural foramina, epidural space, sympathetic chain, costotransverse space, intercostal space and erector spinae plane in all volunteers, but the extent of craniocaudal spread was variable (figure 3).
Ipsilateral spread of an injectate to the various anatomical sites (as assessed on MRI) after a single-level ITPB at the retro-SCTL space. ITPB indicates intertransverse process block; SCTL, superior costotransverse ligament
Injectate spread to the various anatomical sites (as seen on MRI) after a single-level ITPB at the retro-SCTL space. MRI images from volunteer 1 (A to C) shows predominantly unilateral spread whereas volunteer 2 (D to F) demonstrates significant bilateral spread. ITPB indicates intertransverse process block; SCTL, Superior costotransverse ligament
Number of ipsilateral and contralateral anesthetised (sensory score 0/2) and hypoaesthetic (sensory score 1/2) dermatomes over the anterior and posterior thorax after a single-level ITPB at the retro-SCTL space. ITPB indicates intertransverse process block; SCTL, superior costotransverse ligament
Conclusions An ITPB at the retro-SCTL space consistently spreads to the ipsilateral paravertebral space, neural foramina, epidural space, sympathetic chain, costotransverse space, and intercostal space but produces ipsilateral sensory blockade that is variable and wider over the posterior, than anterior, thorax.