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Cervical erector spinae plane block: a cadaver study.

Hesham Elsharkawy1, Ilker Ince2, Hassan Hamadnalla3

  • 1Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, USA.

Regional Anesthesia and Pain Medicine
|April 24, 2020
PubMed
Summary
This summary is machine-generated.

Cervical erector spinae plane (ESP) blocks at C6/C7 can spread to the brachial plexus (BP). This cadaver study suggests ESP blocks may offer pain relief for shoulder and neck surgeries.

Keywords:
anatomybrachial plexusupper extremity

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Area of Science:

  • Anesthesiology
  • Anatomy
  • Regional Anesthesia

Background:

  • The mechanism by which cervical erector spinae plane (ESP) blocks anesthetize the brachial plexus (BP) is not fully understood.
  • The prevertebral fascia forms a compartment containing the phrenic nerves, BP, and erector spinae muscles, suggesting potential spread from cervical ESP injections.
  • This study aimed to investigate the spread of local anesthetic from cervical ESP injections in cadavers.

Purpose of the Study:

  • To evaluate the spread of local anesthetic injected into the cervical erector spinae plane (ESP) at C6 and C7 levels in cadavers.
  • To determine if injections reach the brachial plexus (BP) and surrounding structures.
  • To elucidate the anatomical basis for the analgesic effects of cervical ESP blocks.

Main Methods:

  • Ultrasound-guided injections of a water and India ink mixture were performed into the ESP at C6 and C7 levels in five cadavers.
  • Injections were administered bilaterally, with C6 on one side and C7 on the contralateral side.
  • Cadaver dissections were performed to record the extent of dye spread and direct nerve staining, categorized as deep, faint, or none.

Main Results:

  • Cervical ESP injections consistently stained the roots of the brachial plexus (BP) and dorsal rami.
  • Variable staining of C8 (100%) and T1 (50%) nerve roots was observed.
  • The phrenic nerve showed staining in three injections (deep in one, faint in two), and anterior scalene muscles were stained in 40% of cases.

Conclusions:

  • Ultrasound-guided cervical (C6 and C7) ESP injections demonstrate consistent staining of brachial plexus (BP) roots and dorsal rami.
  • The spread pattern supports the potential for cervical ESP blocks to provide analgesia for shoulder and cervical spine procedures.
  • This anatomical study provides evidence for the mechanism of action of cervical ESP blocks in regional anesthesia.