• Victor Varela, Carlos Ruíz, Sara Montecinos, Alberto Prats-Galino, and Xavier Sala-Blanch.
• Master in Advanced Medical Skills in Regional Anesthesia Based in Anatomy, University of Barcelona, Barcelona, Spain.
• Reg Anesth Pain Med. 2024 Mar 4; 49 (3): 228232228-232.

IntroductionParaspinal fascial plane blocks have become popular and include the erector spinae plane (ESP) and intertransverse process (ITP) blocks. Controversy exists regarding the exact mechanism(s) of these blocks. We aimed to evaluate the spread of local anesthetic (LA) following ESP and ITP blocks as compared with paravertebral (PV) blocks in a cadaveric model.MethodSingle-injection ultrasound guided ESP (n=5), ITP (n=5), and PV (n=5) blocks were performed in 15 fresh cadaver hemithoraces. The extent of LA spread within the erector spinae fascial plane, involvement of the dorsal ramus, and distribution within the PV space, were qualitatively described.ResultsThe spread of LA following ESP block extended eight vertebral levels in a cranio-caudal direction, involving the dorsal ramus at each level, but without LA spread into the PV space nor to the ventral rami. LA spread following ITP block extended 1-2 vertebral levels within the PV space and 7 vertebral levels within the erector spinae fascial plane. The spread of LA following PV blocks extended 2-4 vertebral levels, involving the ventral and dorsal ramus at each level, but without LA spread into the ESP.ConclusionBased on the results of this cadaveric experimental model of paraspinal fascial plane blocks, LA spread following ITP blocks extends into both the PV space and the erector spine fascial plane, and thus may offer a more favorable analgesic profile than ESP blocks.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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