Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study

作者：Shan Tao, Xiaodan Zhang, Zhenyu Zhao, Xiao Zhou, H. Bao, Chuan Su, Qilian Tan, Liu Han, Jun Yin · 发表于：British Journal of Anaesthesia · 年份：2025 · DOI：10.1016/j.bja.2024.10.046 · 被引用次数：37 · 研究领域：Medicine

Background Spread of local anaesthetic solution in the paravertebral space after erector spinae plane block (ESPB) is variable. We evaluated whether paravertebral spread of local anaesthetic is affected by patient position after ESPB. Methods We randomised 84 patients to receive ESPB at T7 with a mixture of 0.375% ropivacaine and radiocontrast dye (30 ml). Participants were positioned supine, prone, or lateral for 30 min after ESPB before computed tomography scanning. The primary outcome was paravertebral space local anaesthetic spread, with secondary assessments of craniocaudal spread and distribution to neural foramina, and intercostal and epidural spaces. Loss of sensation to cold was recorded. Results Local anaesthetic–contrast mix reached the paravertebral space, intercostal space, and neural foramina in 96.5%, 94.2%, and 77.9% of individuals, respectively. Epidural space spread occurred in 20 cases. Prone positioning consistently allowed paravertebral and intercostal spread in all patients, with more thoracic level spread compared with supine positioning (5.0 [1.9] vs 3.1 [1.7], difference [95% confidence interval, CI]: 1.9 [0.8–3.0] levels, P<0.001 for paravertebral space spread; 2.8 [1.9] vs 1.4 [1.4], difference [95% CI] levels: 1.4 [0.4–2.5], P=0.004 for neural foramina spread; 4.3 [1.3] vs 3.2 [1.5], difference [95% CI] levels: 1.0 [0.1–1.9], P=0.019 for intercostal space spread). Local anaesthetic–contrast extended to the intercostal space further in the prone tha...