Topographic and anatomic justification of the safety of subtransversal method of paravertebral block in comparison with ESP block and paravertebral block in the experiment on unfixed cadaveric material

Introduction. Regional anesthesia is gaining popularity in anesthesiology. In thoracoabdominal surgery, the ESP block (erector spinae plane block) and TPV block (thoracic paravertebral block) are frequently used. There is evidence of anesthetic penetration into the epidural space, leading to the development of a sympathetic block. We hypothesize that subtransversal administration of the anesthetic provides a more effective analgesic effect due to a greater influence on the sympathetic trunk, splanchnic nerves, and thoracoabdominal nerves with limited diffusion into the epidural space.

The objective was to conduct a comparative evaluation of the spread of contrast with anesthetic in the subtransversal space when performing ESP block, TPV block, and subtransvertal method of paravertebral block.

Materials and methods. The study was conducted on 30 cadavers: ESP-block group (n = 10), TPV-block group (n = 10), and subtransvertal method of paravertebral block group (n = 10). The procedure was performed at the level of Th7–Th8 under ultrasound guidance through an 18G needle with infusion of 20 ml of 0.2% Ropivacaine solution with contrast at a rate of 5 ml/min. Then, dissection was performed, and the area of dye spread and the degree of diffusion were analyzed.

Results. Statistically significant differences were found in the number of involved spinal nerve roots, splanchnic nerves, and the frequency of diffusion into the pleural cavity and internal organs (p < 0.05). The maximum number of involved spinal nerve roots was observed with ESP block (7 segments), and the minimum with TPV block (2 segments). The greatest spread along the splanchnic nerves and diffusion into the internal organs were recorded with the subtransversal method of paravertebral block. The frequency of intercostal vessel damage did not differ statistically (p > 0.05).

Conclusion. The subtransversal method of paravertebral block provides the greatest involvement of nerve structures, which allows us to hypothesize its effect on both the sympathetic and parasympathetic nervous systems. Further research is needed to evaluate the effectiveness of the method.

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