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. 2022 Feb;52(1):229-236.
doi: 10.3906/sag-2107-83. Epub 2022 Feb 22.

The lumbar erector spinae plane block: a cadaveric study

Serdar Kokar  1 , Ahmet Ertaş  2 , Özlem Mercan  3 , Fatma Güler Yıldırım  2 , Ömer Alp Taştan  2 , Kenan Akgün  1
Affiliations

The lumbar erector spinae plane block: a cadaveric study

Serdar Kokar et al. Turk J Med Sci. 2022 Feb.

Abstract

Background: The aim of this cadaveric study was to investigate the erector spinae plane block (ESPB) in lumbar region and to elucidate the possible mechanisms of action of these injections in lumbar radicular pain by means of detecting expected dye dispersion to the neural structures.

Methods: Ultrasound-guided lumbar ESPB was performed in three formaldehyde-embalmed human cadavers. For this purpose, a 10 mL of methylene blue was injected into the fascial space between the L4 transverse process and the erector spinae muscles. T hen, the cadavers were dissected, the cephalocaudal and lateral spread of the dye was examined, and the involvement of the dorsal rami, dorsal root ganglia and ventral rami were analyzed. The distribution into the epidural space was also evaluated.

Results: The involvement of the dorsal rami was found to extend up to the T12 level and down to the L5 spinal nerves. Although dye dispersion was detected on the dorsal root ganglion in all specimens, it was found to be limited to one or two levels, unlike the dorsal rami. In half of the specimens, distribution to the ventral ramus and posterior epidural space was observed.

Keywords: Interventional ultrasonography; low back pain; regional anesthesia.

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Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Fascial space (arrows). The probe in the longitudinal parasagittal orientation (left bottom). (B) The spinal needle advancing from the cephalic to caudal direction using in-plane technique (arrow heads). The needle tip (arrow) located in the target fascial space. (C) Linear spread of the fluid throughout the fascial space (arrows). L3 TP, L3 transverse process; L4 TP, L4 transverse process.
Figure 2
Figure 2
(A) Involvement of posterior rami. Please note that the spread of methylene blue is mostly unidirectionally with predominantly cephalic or caudal staining (each posterior ramus written in the figure). Lateral spread extends up to medial part of iliac crest. (B) Staining of dorsal root ganglia (dashed circles) and epidural region (dashed rectangle).
Figure 3
Figure 3
(A) Staining of ventral ramus of L3 hold by an orange wire. (B) No staining in anterior epidural space or posterior to the intervertebral discs.
Figure 4
Figure 4
A schematic view of lumbar vertebrae and related muscles. Deep to the erector spinae muscles, the spinal needle extending into the fascial space (target) between the transverse process and muscle group. PM, Psoas Major; QL, Quadratus Lumborum; Ic, Iliocostalis; Lo, Longissimus; Mf, Multifidus; TP, transverse process.
See this image and copyright information in PMC

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