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. 2022 Apr;75(2):185-187.
doi: 10.4097/kja.21457. Epub 2021 Nov 22.

The novel continuous bilateral parascapular sub-iliocostalis plane block for thoracic spinal surgery

Carlos Rodrigues Almeida  1 , Lígia S Vieira  1 , Emília M Francisco  1 , Pedro F Antunes  1
Affiliations

The novel continuous bilateral parascapular sub-iliocostalis plane block for thoracic spinal surgery

Carlos Rodrigues Almeida et al. Korean J Anesthesiol. 2022 Apr.
No abstract available

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Presentation of patient’s post-operative X-ray and description of the parascapular sub-iliocostalis plane (PSIP) block (ultrasound image and schematic representation). (A) Postoperative X-ray showing a transpedicular T4 to T7 transpedicular spine fixation. (B) Description of the PSIP block. With the patient in the left lateral decubitus position, a high-frequency linear ultrasound probe is placed at a parasagittal orientation 2 cm from the medial scapular border at the level of the edge of the scapular spine (fourth rib level). The ultrasound depth is 3 cm. The PSIP block relies on the identification of the lateral border of the iliocostalis muscle (ILCM). To avoid confusion with the other muscles (such as the longissimus, rhomboid, or posterior-superior serratus muscle), the injection is performed medial to this border. The tendinous insertion of the ILCM at the rib is in the superolateral direction (it should not be confused with the insertion of the levatores costarum muscles, whose insertion is in the inferior-lateral direction). We chose to perform the PSIP block at the T4 level to take advantage of the gravity effect when the patient is in a sitting position or during ambulation. No significant lateral spread was seen to the lateral border of the ILCM. (C) A schematic representation of the relevant anatomy for a PSIP block. The injection is performed superficially to rib in the sub-iliocostalis plane. At the upper levels, the serratus posterior-superior muscle may be observed below the rhomboid major or rhomboid minor muscles. Of note, at the thoracic level, the iliocostalis dorsi muscle does not have any insertion site at any component of vertebrae in opposition to the longissimus dorsi or spinalis dorsi muscles. TM: trapezius muscle, RMM: rhomboid major muscle, LA: local anesthetic.
See this image and copyright information in PMC

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