Intertransverse process block (ITPB) at the retro-superior costotransverse ligament (retro-SCTL) space: Evaluation of local anesthetic spread using MRI and sensory blockade in healthy volunteers
Authors' conclusion
A single-injection medial retro-SCTL space block, at the T4-T5 level with 10.5 ml of local anesthetic, consistently spreads to the ipsilateral intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space, but produces ipsilateral sensory blockade that is variable and wider over the posterior than anterior hemithorax.
Study context
- Population
- Healthy volunteers receiving a medial retro-SCTL space block at T4-T5 (10 ml 0.5 % bupivacaine with 0.5 ml gadolinium)
- Participants
- 10 volunteers
- Outcome
- Local anaesthetic spread (MRI) and sensory blockade
Methodological detailshealthy volunteers, single-injection, ultrasound-guided, MRI, MRI at 15 min; loss of sensation to cold at 15 and 60 min, then hourly for 5-h
- Healthy volunteers
- Single-injection
- Ultrasound-guided
- MRI
- MRI at 15 min; loss of sensation to cold at 15 and 60 min, then hourly for 5-h
Main finding
As reported in the abstract
Median [IQR] dermatomes
3.5 [2-5] vs 0 [0-1.25]
P < 0.001
Hypoesthesia, anterior hemithorax vs Anesthesia, anterior hemithorax
Median [IQR] dermatomes
6[3-7] vs 2[1-3]
P < 0.001
Hypoesthesia, posterior hemithorax vs Anesthesia, posterior hemithorax
Median [IQR] dermatomes
2[1-3] vs 0[0-1.25]
P = 0.01
Anesthesia, posterior hemithorax vs Anesthesia, anterior hemithorax
- Spread to intercostal and paravertebral spaces, sympathetic chain, costotransverse space, neural foramina and epidural space in all participants
- 100 %
- Contralateral dermatomes affected
- 3 (30 %)
Further findings
Correlation of LA spread with ipsilateral dermatomes
- Hypoesthetic dermatomes, r = 0.53
- P = 0.11
- Anesthetic dermatomes, r = 0.09
- P = 0.78
- No statistically significant correlation
Original publication
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