Comparison of Injection Spread of Upper and Mid Thoracic Erector Spinae Plane Block
Study Details
Study Description
Brief Summary
The primary endpoint of this study was to identify eretor spinae plane block (ESPB) spread level in the cranio-caudal direction. The secondary endpoint was to identify the incidence of spread of epidural, intercostal, paravertebral and intravascular injections with upper and mid thoracic ESPB.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
N/A |
Detailed Description
The erector spinae plane block (ESPB) is a less invasive, safer, and technically easy alternative procedure to conventional neuraxial anesthetic techniques. In contrast to common neuraxial techniques such as paravertebral and epidural injections, the ESPB targets an interfascial plane which is far from the spinal cord, root, and pleura. First applied to thoracic neuropathic pain, currently ESPB is being applied to postoperative pain control and includes variable clinical situations. In the abdomen and thoracic wall, thoracic ESPB can be applied for pain control after cardiac surgery, video-assisted thoracic surgery, laparoscopic cholecystectomy, and thoracotomy. Recently, favorable postoperative pain control after lumbar spinal or lower limb surgeries has been reported with lumbar ESPB. In addition, ESPB has also been used for chronic pain conditions in the upper and lower extremities. To investigate the possible mechanism of action of the ESPB, many previous studies have focused on examining the physical spread of the injected agent. Commonly, contrast dye injections in human cadavers have been utilized to assess the spread level. Physical spread level was determined using various methods including direct dissection or sectioning, computed tomography (CT), thoracoscopic inspection, or magnetic resonance imaging (MRI) with radiocontrast injection. Apart from human cadaver studies, physical spread level has been evaluated in alive patients using a variable volume of local anesthetics mixed with radiocontrast. However, these studies are limited by the small number of included patients. Therefore, the exact spread level of injected local anesthetics remains unclear and a study on a large number of patients is still required.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: upper thoracic ESPB group Group where ESPB is performed at T2 with local anesthetic mixture 20 ml |
Procedure: Erector spinae plane block
fascial plane injection guided by fluoroscopy device
|
Active Comparator: mid thoracic ESPB group Group where ESPB is performed at T6 with local anesthetic mixture 20 ml |
Procedure: Erector spinae plane block
fascial plane injection guided by fluoroscopy device
|
Outcome Measures
Primary Outcome Measures
- spread level in the cranio-caudal direction [1 minutes after erector spinae plane block]
fluoroscopic contrast medium spread level in the cranio-caudal direction
Secondary Outcome Measures
- Number of participant showing epidural spread [baseline, 1 minute after erector spinae plane block]]
Number of participant showing epidural spread by analysis of fluoroscopic image
- Number of participant showing intercostal spread [baseline, 1 minute after erector spinae plane block]]
Number of participant showing intercostal spread by analysis of fluoroscopic image
- Number of participant showing paravertebral spread [baseline, 1 minute after erector spinae plane block]
Number of participant showing paravertebral spread by analysis of fluorosocpic image
- Number of participant showing intravascular spread [baseline, 1 minute after erector spinae plane block]
Number of participant showing intravascular spread by analysis of fluorosocpic image
Eligibility Criteria
Criteria
Inclusion Criteria:
-
cervical spinal stenosis
-
cervical disc herniation
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cervical facet arthropathy
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myofascial pain syndrome of upper back muscle
-
herpes zoster
-
postherpetic neuralgia
Exclusion Criteria:
-
Allergy to local anesthetics or contrast medium
-
Pregnancy
-
Spine deformity
-
Patients with coagulation abnormality
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Hong ji HEE | Daegu | Korea, Republic of | 42601 |
Sponsors and Collaborators
- Keimyung University Dongsan Medical Center
Investigators
- Principal Investigator: Ji H Hong, Ph.D, Keimyung University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2022-01-026-03