High variability of in-depth injective spread in the erector spinae plane block: a cadaveric anatomical insight

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...

The back muscles that lie deep into the thoracolumbar fascia are called intrinsic or true back muscles. These muscles are divided into four layers: superficial, intermediate, deep, and deepest layers.
Superficial Layer:
The superficial layer consists primarily of the splenius muscles, which include the splenius capitis and splenius cervicis. These muscles are mainly responsible for the head and cervical spine movements, including extension, rotation, and lateral bending. The splenius capitis...

The cross-sectional anatomy of the spinal cord offers a detailed view of its complex structure and function within the central nervous system. At the core of the spinal cord lies the gray matter, characterized by its butterfly or "H"-shaped appearance in cross-section. This central region is enveloped by white matter, with the overall structure divided into symmetrical halves by the dorsal median sulcus and the ventral median fissure.
Gray Matter and its Components
Central to the gray matter is...