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Relationship between injectate volume and disposition in erector spinae plane block: a cadaveric study
  1. Jeffrey Gadsden1,
  2. Jeffrey Gonzales2 and
  3. An Chen3
  1. 1 Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
  2. 2 Pacira BioSciences, Parsippany, New Jersey, USA
  3. 3 Anesthesiology, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, USA
  1. Correspondence to Dr Jeffrey Gadsden, Duke University Medical Center, Durham, USA; jeff.gadsden{at}


Introduction Erector spinae plane (ESP) blocks can be used to provide analgesia following thoracoabdominal and lumbar spine surgical procedures. However, the influence of injectate volume and injection location on the spread of anesthetic with ESP blocks remain unclear.

Methods Ultrasound-guided ESP injections were performed on two fresh cadavers using a solution of iopamidol radiographic contrast, indocyanine green or methylene blue dye, and saline. The relationship between injectate volume and cephalocaudal spread was assessed using real-time fluoroscopic recordings after incremental ESP injections to the lumbar and thoracic region. Cadavers were then dissected to expose tissue staining and document the precise disposition of the dye within the ES muscle, paravertebral space, dorsal and ventral rami, and other relevant structures.

Results Larger injection volumes resulted in more extensive cephalocaudal spread in most cases, with fluoroscopic images revealing a small but direct relationship between injectate volume and contrast spread. Dissection reinforced the radiographic findings, with staining ventral to the ES muscle ranging from 4 to 7 paravertebral levels with injections of 30–40 mL vs 12–13 levels following injections of 60–80 mL. No spread of dye to the lamina, transverse processes, paravertebral space, epidural space, or pleura was observed following any injection.

Conclusions Increased ESP injection volumes resulted in more extensive cephalocaudal spread, resulting in anesthetic spread to the dorsal rami and ventral ES muscle without involvement of the ventral rami or other anterior structures. Injection volumes of 30 mL may be optimal for ESP blocks requiring analgesia across 4–7 levels.

  • Nerve Block
  • analgesia
  • Anesthesia, Local

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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  • Contributors JG stands as guarantor for the overall content. All authors conceived and carried out the study and participated in the manuscript writing. All authors approved the final manuscript.

  • Funding Funding for this study was provided by Pacira BioSciences. The sponsor was involved in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the manuscript for publication. Writing and editorial assistance was provided under the direction of the authors by Katie Yoest, PhD and David Boffa, ELS, of MedThink SciCom, and funded by Pacira BioSciences.

  • Competing interests J Gadsden has received research funding and consulting fees from Pacira Biosciences. J Gonzales is an employee of Pacira BioSciences and may hold stock and/or stock options in the company. AC has nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.