A cadaveric study of the erector spinae plane block in a neonatal sample

Abstract

BackgroundThe aim of this article was to provide a detailed description of the neonatal anatomy related to the erector spinae plane block and to report the spread of the dye within the fascial planes and potential dermatomal coverage.MethodsUsing ultrasound guidance, the bony landmarks and anatomy of the erector spinae fascial plane space were identified. The erector spinae plane block was then replicated unilaterally in two fresh unembalmed neonatal cadavers. Using methylene blue dye, the block was performed at vertebral levels T5—using 0.5 mL in cadaver 1—and T8—using 0.2 mL in cadaver 2. The craniocaudal spread of dye was tracked within the space on the ultrasound screen and further confirmed on dissection.ResultsCraniocaudal spread was noted from vertebral levels T3 to T6 when the dye was introduced at vertebral level T5 and from vertebral levels T7 to T11 when the dye was introduced at vertebral level T8. Furthermore, the methylene blue spread was found anteriorly in the paravertebral and epidural spaces, staining both the dorsal and ventral rami of the spinal nerves T2 to T12. Small amounts of dye were also found in the intercostal spaces.ConclusionIn two neonatal fresh cadavers, the dye was found to spread to multiple levels and key anatomic locations.

Early experience with erector spinae plane blocks in children

“…Based on our findings in the subset of gastrostomy patients, we suggest that at least 0.1 mL/kg of local anesthetic is required per dermatome in infants and toddlers. This suggestion is supported by a recent cadaveric study …”

“…A recent study in two neonatal cadavers supports this premise . Methylene blue diluted in normal saline was injected into the erector spinae plane under ultrasound guidance in two fresh, premature, neonatal cadavers.…”

The anatomical features of an ultrasound‐guided erector spinae fascial plane block in a cadaveric neonatal sample

“…The mechanism of action is believed to be by anterior spread of local anesthetic through the intertransverse connective tissue into the paravertebral, epidural, and intercostal spaces as seen in this study. 7,8 The erector spinae muscle sheath and the thoracolumbar fascia facilitate extensive multi-dermatomal spread of the erector spinae plane block. 9 Since tissue plane blocks are volume dependent, the dermatomal coverage should be related to the volume used.…”

Erector spinae catheter for post-thoracotomy pain control in a premature neonate

“…We aimed to place the catheter tip at the midpoint (T5-6) between the planned T4-T5 incision and T7-8 chest tube sites to achieve sufficient cephalad and caudal spread of the local anaesthetic solution to provide analgesia at both sites of source of postoperative pain. 11 We injected 1. was confirmed with 0.5 mL normal saline and 2 mL 3% chloroprocaine. The catheter was tunnelled away from the planned surgical site (figure 1B-D) and secured with a sterile dressing.…”

“…We aimed to place the catheter tip at the midpoint (T5-6) between the planned T4-T5 incision and T7-8 chest tube sites to achieve sufficient cephalad and caudal spread of the local anaesthetic solution to provide analgesia at both sites of source of postoperative pain. 11 We injected 1.5 mL normal saline to open the ESP and threaded a 24-gauge epidural catheter into the plane. Catheter location was confirmed with 0.5 mL normal saline and 2 mL 3% chloroprocaine.…”