Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study
Primary result · Paravertebral space spread (thoracic levels)Result — go to the resultDifference 1.9 levels 95% CI 0.8–3.0Authors' conclusion
Prone positioning after ESPB significantly enhanced local anaesthetic-contrast spread to the paravertebral space, intercostal space, and neural foramina, suggesting that gravity plays a substantial role in spread.
Study context
- Population
- Patients receiving erector spinae plane block (ESPB) at T7 with 0.375% ropivacaine and radiocontrast dye (30 ml), followed by CT
- Participants
- 84 patients
- Comparison
- Supine vs prone vs lateral positioning for 30 min after ESPB
- Primary endpoint
- Paravertebral space local anaesthetic spread
Methodological detailsthree-dimensional reconstruction imaging study
- Three-dimensional reconstruction imaging study
Primary result
Paravertebral space spread (thoracic levels)
Difference
1.9 levels
95% CI 0.8–3.0
P < 0.001
By group
Prone vs Supine
difference 1.9 levels (95% CI 0.8–3.0); P < 0.001
As reported in the abstract
Further findings
| Outcome | Supine | Prone | Lateral | Difference (levels) (95% CI) | P value | |
|---|---|---|---|---|---|---|
| Neural foramina spread (thoracic levels)Prone vs Supine | 1.4 (SD 1.4) levels | 2.8 (SD 1.9) levels | — not stated in the abstract | 1.4 (0.4–2.5) | P = 0.004 | |
| Intercostal space spread (thoracic levels), prone vs supine | 3.2 (SD 1.5) levels | 4.3 (SD 1.3) levels | — not stated in the abstract | 1.0 (0.1–1.9) | P = 0.019 | |
| −10123Difference, levels (linear scale) |
— not stated in the abstract
| Outcome | Supine | Prone | Lateral | Difference (95% CI) | P value | |
|---|---|---|---|---|---|---|
| Intercostal space spread (thoracic levels), prone vs lateral | — not stated in the abstract | 4.3 (SD 1.3) thoracic levels | 2.6 (SD 1.5) thoracic levels | 1.7 (0.8–2.6) | P < 0.001 | |
| −2024Difference (linear scale) |
— not stated in the abstract
- Neural foramina spread (thoracic levels) — Neural foramina reached overall
- 77.9%
- Intercostal space spread (thoracic levels), prone vs supine — Intercostal space reached overall
- 94.2%
Epidural space spread
- Epidural spread (cases)
- 20
Sensory block in ventral dermatomes (loss of cold sensation)
- Variable in all participants
Original publication
Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study. Br J Anaesth. Published 8 January 2025. doi:10.
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