Erector spinae plane block at the thoracolumbar spine: a canine cadaveric study

Abstract

ObjectiveTo investigate the injectate spread and nerve staining of ultrasound-guided erector spinae plane (ESP) injections at the thoracolumbar spine in canine cadavers. Study designProspective, randomized, descriptive, anatomic study. AnimalsA total of 15 canine cadavers. MethodsThe location of the medial and lateral branches of the dorsal branches of the spinal nerves (DBSN) from the tenth thoracic (T10) to the third lumbar vertebra (L3) were identified by dissection of three cadavers. ESP injections of dye (0.5 mL kg–1) were performed in seven cadavers using as landmarks the T12 transverse process (ESPTp) on one side and the lateral aspect of the T12 mammillary process (ESPMp) on the opposite side. Additionally, five cadavers were injected with dye (0.5 mL kg–1) bilaterally on the lateral aspect of the L2 mammillary process (ESPMp_L2). Nerve staining effect was analyzed after gross anatomic dissections. The number of stained nerves was analyzed using the Mann–Whitney U test. ResultsGross anatomic dissections showed that the medial and lateral branches of the DBSN change their path in relation to the epaxial muscles caudal to T11. Approaches ESPTp and ESPMp at T12 stained 2 (0–2) and 3 (2–4) medial (p = 0.01) and 3 (3–4) and 2 (0–2) lateral (p = 0.03) branches, respectively. Injection ESPMp_L2 stained 3 (2–4) medial and 2 (0–3) lateral branches. Injections ESPMp and ESPMp_L2 produced a preferential cranial spread from the injection site. No ventral branches of the spinal nerves were stained with either technique. Conclusions and clinical relevanceThese results suggest that the mammillary process should be used as anatomic landmark to perform ultrasound-guided ESP blocks in the thoracolumbar spine caudal to T11 when targeting the medial branches of the DBSN. Injections should be performed one spinal segment caudal to the level intended to desensitize.