RT Journal Article
SR Electronic
T1 OP052 Intertransverse process block at the retro-SCTL space: evaluation of injectate spread using MRI and sensory blockade in healthy volunteers
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A31
OP A32
DO 10.1136/rapm-2023-ESRA.52
VO 48
IS Suppl 1
A1 Pangthipampai, Pawinee
A1 Siriwanarangsun, Palanan
A1 Pakpirom, Jatuporn
A1 Sivakumar, Ranjith Kumar
A1 Karmakar, Manoj Kumar
YR 2023
UL http://rapm.bmj.com/content/48/Suppl_1/A31.2.abstract
AB Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Application for ESRA Abstract Prizes: I apply as a Trainee/Resident/Fellow (no age limit)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).Abstract OP052 Figure 1 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 ligamentAbstract OP052 Figure 2 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 ligamentAbstract OP052 Figure 3 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 ligamentConclusions 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.