Journal
KOREAN JOURNAL OF ANESTHESIOLOGY
Volume 75, Issue 4, Pages 295-306Publisher
KOREAN SOC ANESTHESIOLOGISTS
DOI: 10.4097/kja.22138
Keywords
Analgesia; Anatomy; Anesthesia; Nerve block; Postoperative pain; Ultrasonography
Categories
Funding
- Basic Science Re-search Program through the National Research Foundation of Korea (NRF) - Ministry of Education [2021R1 F1A1045873]
Ask authors/readers for more resources
Various techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. These techniques include paravertebral, retrolaminar, erector spinae plane, and intertransverse process blocks. Each technique has different anatomical targets and injectate spreading patterns, resulting in different neural blockade characteristics.
Various techniques for regional anesthesia and analgesia of the thorax are currently being used in clinical practice. A recent international consensus has anatomically classified paraspinal blocks in the thoracic spinal region into the following four types: paravertebral, retrolaminar, erector spinae plane, and intertransverse process blocks. These blocks have different anatomical targets; thus, the spreading patterns of the injectates differ and can consequently exhibit different neural blockade characteristics. The paravertebral block directly targets the paravertebral space just outside the neuraxial region and has an analgesic efficacy comparable to that of the epidural block; however, there are multiple potential risks associated with this technique. Retrolaminar and erector spinae plane blocks target the erector spinae plane on the vertebral lamina and transverse process, respectively. In anatomical studies, these two blocks showed different injectate spreading patterns to the back muscles and the fascia] plane. In cadaveric studies, paravertebral spread was identified, but variable. However, numerous clinical reports have shown paravertebral spread with erector spine plane blocks. Both techniques have been found to reduce postoperative pain compared to controls; however, the results have been more inconsistent than with the paravertebral block. Finally, the intertransverse process block targets the tissue complex posterior to the superior costotransverse ligament. Anatomical studies have revealed that this block has pathways that are more direct and closer to the paravertebral space than the retrolaminar and erector spinae plane blocks. Cadaveric evaluations have consistently shown promising results; however, further clinical studies using this technique are needed to confirm these anatomical findings.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available