Ultrasound-guided sacral multifidus plane block for sacral spine surgery

Mistry, Tuhin; Sonawane, Kartik; Balasubramanian, Senthilkumar; Balavenkatasubramanian, Jagannathan; Goel, Vipin Kumar

doi:10.4103/sja.sja_723_21

Cited by 6 publications

(9 citation statements)

References 12 publications

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“…performed the intermediate approach in the sacral spine surgery and observed selective sensory loss in the L4-S3 dermatomes postoperatively [11]. Piraccini The major limitation of this study was the implementation of the ESPB on embalmed cadavers.…”

Section: Discussionmentioning

confidence: 97%

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Comparison of Median, Intermediate, and Lateral Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

KELEŞ

SALMAN

YILMAZ

et al. 2023

Preprint

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Backgrounds: Erector spinae plane block (ESPB) has become very popular for post-operative and chronic pain management. It is aimed to observe the contrast agent distributions of three different methods anatomically and radiologically in ultrasound-guided sacral ESPB interventions.Materials and Methods: Six cadavers were enrolled and they were grouped into three groups; median, intermediate, and lateral approaches. An ultrasound-guided ESPB was performed with a mixture of radio-opaque and dye. After 30 minutes, the distribution of the solution was observed in the cadavers by computed tomography (CT) examination. Totally after 60 minutes of intervention, the median and intermediate groups of cadavers were dissected in order to observe the dye spread in the median group and the intermediate group. The lateral group dissection wasn’t performed according to radiologic findings.Results: CT images presented a pooling of the radio-opaque at subcutaneous tissue in the median group, at erector spinae in the intermediate group, and at gluteus maximus in the lateral group of cadavers. In addition to compartment spreads, images presented anterior transition of the contrast agent at only median group cadavers. Dissection findings presented pooling of the methylene blue at subcutaneous tissue between S1 and S5 horizontal planes at the median group. The red acrylic paint spread was detected between L2-S3 levels in the erector spinae muscle group.Conclusion: Radiocontrast dye was detected at superficial, erector spinae, and gluteus maximus compartments respectively at median, intermediate, and lateral cadaver groups both radiological and anatomically. Anterior transition of the radiocontrast was detected in only the median cadaver group.

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Section: Discussionmentioning

confidence: 97%

“…[10]. Mistry et al reported a case of ultrasound-guided sacral multi dus plane block for spine surgery, they performed a block bilaterally between the median and intermediate crests at S2 level [11].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Median, Intermediate, and Lateral Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

KELEŞ

SALMAN

YILMAZ

et al. 2023

Preprint

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“…We assess that the difference between our study results is due to the difference in the methods of both studies. Mistray et al performed the intermediate approach in the sacral spine surgery and observed selective sensory loss in the L4-S3 dermatomes postoperatively [11]. Piraccini et al perform the sacral ESPB with an intermediate approach unilaterally, from the S1 level, with a 15 cc drug, and the radicular pain numerical rating scale of the patient was decreased after 20 minutes, and the patient was able to stand up and walk [8].…”

Section: Discussionmentioning

confidence: 99%

“…In the same year, Aksu and Gürkan reported effective postoperative analgesia in a pediatric patient who underwent hypospadias surgery by performing the median sacral ESPB from the median sacral crest [5]. There are successful case reports of both techniques reported in the literature [6][7][8][9][10][11] The current literature includes both median and intermediate ESPB implementations. However, there is no anatomical and radiological study in the literature describing the application and the method of the median (midline) and intermediate ESPB practices.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Median and Intermediate Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

KELEŞ

SALMAN

YILMAZ

et al. 2023

Preprint

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Backgrounds: Erector spinae plane block (ESPB) has become very popular for post-operative and chronic pain management. ESPB applications sacral area procedures have been named 'sacral ESPB’. This study is aimed to conduct a cadaveric study to determine how local anesthesia was distributed at median and intermediate approaches of the sacral region ESPB procedures. Materials and Methods: Four cadavers were grouped into two groups; median and intermediate approaches. An ultrasound-guided ESPB was performed with a mixture of radiocontrast and dye. After the distribution of the solution was observed by computed tomography, cadavers were dissected in order to observe the dye spread in the groups. Results: CT Images of the median group demonstrated subcutaneous pooling of contrast agents between S1 and S5 horizontal planes. Contrast agent passing from the sacral foramina to the anterior of the sacrum via spinal nerves was also observed between S2-S5. In the intermediate group contrast distribution was observed along the bilateral erector spinae muscle between L2-S3 horizontal planes, and no anterior transition was detected. Dissection findings in the median group, methylene blue spread was observed in the subcutaneous tissue area between the S1-S5 horizontal planes. There was no methylene blue solution spread under the superficial fascia or the muscle plane. In the intermediate group, the red-colored radiocontrast solution was detected between the L2-S3 intervertebral levels in the erector spinae muscle group. Conclusion: Radiocontrast dye was detected at superficial and erector spinae compartments respectively at median and intermediate cadaver groups both radiological and anatomically. The anterior transition of the radiocontrast was detected in only the median cadaver group. Clinical Trial: Karadeniz Technical University Ethics Approval No: 2022/229, ClinicalTrials.gov ID: NCT05716061

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“…In the same year, Aksu and Gürkan [5] reported adequate postoperative analgesia in a pediatric patient who underwent hypospadias surgery using the median approach to the SESPB, from the median sacral crest. There are radiological, anatomical, or clinical studies of SESPB in the current literature, but there is no anatomical and radiological study comparing the two methods of SESPB [6][7][8][9][10][11]. The present cadaveric study aimed to determine the distribution of local anesthesia with the median and intermediate SESPB approaches.…”

Section: Introductionmentioning

confidence: 96%

Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study

Keleş,

Salman,

Yılmaz

et al. 2024

Korean J Anesthesiol

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Background: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB.Methods: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution.Results: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels.Conclusions: Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

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Ultrasound-guided sacral multifidus plane block for sacral spine surgery

Cited by 6 publications

References 12 publications

Comparison of Median, Intermediate, and Lateral Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

Comparison of Median, Intermediate, and Lateral Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

Comparison of Median and Intermediate Approach in the Ultrasound-Guided Sacral Erector Spinae Plane Block: A Cadaveric and Radiologic Study

Comparison of the median and intermediate approaches to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study

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