Path of Least Resistance: Multilevel Epidural Spread Following Large Volume Intertransverse Process Injection
Authors' conclusion
These findings support anatomical continuity between the ITP and epidural spaces. Compared with 10 mL, 20 mL ITP injections showed greater variability and occasional extensive epidural spread
Study context
- Population
- Adult cadavers (6 traditionally embalmed, 2 GreenMBalmed), anatomy laboratory at an academic medical institutioninjections in 8 cadavers
- Participants
- 12 participants
- Exposure
- Intertransverse process (ITP) block with 20 mL vs 10 mL
- 20 mLn = 6
- 10 mLn = 6reference
- Outcome
- Paraspinal injectate spread to intercostal nerves, paravertebral space and anterior/posterior epidural spaces
Methodological detailsprospective
- Prospective
Main finding
As reported in the abstract
Dye spread (levels)
- Paravertebral spread, all injections
- 11 of 12
- 10 mL: median paravertebral spread
- 2 levels
- 10 mL: median intercostal spread
- 1.5 levels
- 20 mL: median spread in paravertebral and intercostal spaces
- 2 levels
- Epidural spread (anterior and/or posterior), each volume group
- 5 of 6
- Multilevel epidural spread (≥3 levels), 20 mL
- 3 of 6
- Multilevel epidural spread (≥3 levels), 10 mL
- 0 of 6
- 20 mL: anterior epidural spread range
- 0 to 5 levels
- 20 mL: posterior epidural spread range
- 0 to 7 levels
Observational data: associations, not effects.
Original publication
Path of Least Resistance: Multilevel Epidural Spread Following Large Volume Intertransverse Process Injection. J Cardiothorac Vasc Anesth. Published 3 March 2026. doi:10.
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