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Updated: Sep 4, 2025
Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
The Retro Superior Costotransverse Ligament Space as a New Target for Ultrasound-Guided Intertransverse Process
Manoj Kumar Karmakar1, Ranjith Kumar Sivakumar1, Kenneth Sheah2
1From the Department of Anesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China.
An intertransverse process block (ITPB) is a paraspinal thoracic nerve block technique, where the local anesthetic (LA) is injected into the thoracic intertransverse tissue complex posterior to the superior costotransverse ligament (SCTL). Although an ITPB can be ultrasound-guided, it is performed using surrogate bony landmarks without even identifying the SCTL. This report describes a transverse ultrasound imaging technique to identify the retro-SCTL space and perform an ITPB with a retro-SCTL space injection, in 2 patients undergoing video-assisted thoracoscopic surgery. The resultant bilateral, symmetrical, thoracolumbar anesthesia was consistent with epidural spread of the LA and effective for perioperative analgesia.
An intertransverse process block (ITPB) is a paraspinal thoracic nerve block technique, where the local anesthetic (LA) is injected into the thoracic intertransverse tissue complex posterior to the superior costotransverse ligament (SCTL). Although an ITPB can be ultrasound-guided, it is performed using surrogate bony landmarks without even identifying the SCTL. This report describes a transverse ultrasound imaging technique to identify the retro-SCTL space and perform an ITPB with a retro-SCTL space injection, in 2 patients undergoing video-assisted thoracoscopic surgery. The resultant bilateral, symmetrical, thoracolumbar anesthesia was consistent with epidural spread of the LA and effective for perioperative analgesia.
