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Unpredictable Injectate Spread of the Erector Spinae Plane Block in Human Cadavers

Dautzenberg, Karin H. W. MD*; Zegers, Marissa J. MD*; Bleeker, Chris P. MD*; Tan, Edward C. T. H. MD, PhD; Vissers, Kris C. P. MD, PhD*; van Geffen, Geert-Jan MD, PhD*; van der Wal, Selina E. I. MD, PhD*

doi: 10.1213/ANE.0000000000004187
Regional Anesthesia and Acute Pain Medicine

We performed bilateral ultrasound-guided erector spinae plane blocks at the second and eighth thoracic vertebrae in 11 fresh frozen cadavers. Methylene blue dye spread variably and extensively deep to the erector spinae muscles fascia with involvement of the spinal rami and paravertebral space in 1 of 11 cadavers when injected at the eighth thoracic vertebra, and in 4 of 11 cadavers at the second thoracic vertebra, with crossover to the contralateral side of the spine. Our study demonstrates that in cadavers, an erector spinae plane block follows the fascial planes with unpredictable spread, which might explain its varying clinical efficacy.

From the Departments of *Anesthesiology, Pain and Palliative Medicine

Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

Published ahead of print 18 March 2019.

Accepted for publication March 18, 2019.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Karin H. W. Dautzenberg, MD, Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, the Netherlands. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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