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The pathway of injectate spread during thoracic intertransverse process (ITP) block: Micro-computed tomography findings and anatomical evaluations

Authors
 Tae-Hyeon Cho  ;  Hyun-Jin Kwon  ;  Jehoon O  ;  Jaehee Cho  ;  Shin Hyung Kim  ;  Hun-Mu Yang 
Citation
 JOURNAL OF CLINICAL ANESTHESIA, Vol.77 : 110646, 2022-05 
Journal Title
JOURNAL OF CLINICAL ANESTHESIA
ISSN
 0952-8180 
Issue Date
2022-05
MeSH
Cadaver ; Humans ; Inosine Triphosphate* ; Nerve Block* / methods ; Thoracic Vertebrae / diagnostic imaging ; Ultrasonography, Interventional / methods ; X-Ray Microtomography
Keywords
Clinical anatomy ; Regional anesthesia ; Ultrasonography
Abstract
Study objective: To investigate the mechanism of action of the thoracic intertransverse process (ITP) block.

Design: Three-dimensional micro-computed tomography (3D micro-CT) study and cadaveric evaluation.

Setting: A translational research unit for anatomy and analgesia in a university hospital.

Patients: Twelve embalmed and three non-embalmed human cadavers were used in this study.

Measurements: Micro-CT images of the mid-thoracic paravertebral space and its adjacent ligamentous tissues were acquired and 3D images were reconstructed. Manual dissection and histologic examination of these structures complemented the images. To confirm our findings, the dye-spreading pattern after ultrasound-guided ITP injection of 20 mL dye solution at T4-T5 was evaluated.

Main results: Micro-CT and histologic findings showed that the costotransverse foramen (the medial slit of the superior costotransverse ligament) and the costotransverse space (between the rib and the transverse process) were potential pathways to the thoracic paravertebral space during ITP block. Single-level ITP injection with a dye solution resulted in a multilevel segmental paravertebral spread in cadaveric evaluation.

Conclusions: The space posterior to the superior costotransverse ligament, the target area for ITP blocks, has potential anatomical pathways to the thoracic paravertebral space. The costotransverse foramen and the costotransverse space provided the anatomical conduit for the anterior and intersegmental paravertebral spread of the ITP block.
Full Text
https://www.sciencedirect.com/science/article/pii/S0952818022000022
DOI
10.1016/j.jclinane.2022.110646
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188332
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