Comparison of Clinical Efficacy and Anatomical Investigation between Retrolaminar Block and Erector Spinae Plane Block

Eiko Onishi, Noriko Toda, Yoshinobu Kameyama, Masanori Yamauchi, Eiko Onishi, Noriko Toda, Yoshinobu Kameyama, Masanori Yamauchi

Abstract

Retrolaminar block (RLB) and erector spinae plane block (ESPB) are alternative approaches to paravertebral block (PVB) and are advantageous in that they are easier and safer techniques compared with the traditional PVB. Many clinical reports of these blocks have described their efficacy for ipsilateral thoracic analgesia. The local anesthetic injection points of RLB and ESPB are the lamina and transverse process, respectively. Despite the similarity of the puncture sites, there have been no clinical studies comparing RLB and ESPB. In addition, the underlying mechanism of these blocks has not been clarified. Recent anatomical investigations indicated that the injectate was distributed in the paravertebral space and spread laterally into the intercostal spaces. The limited distribution into the paravertebral space indicated that compared to PVB, RLB and ESPB exert their effects via a different mechanism. In this review, we describe the features of and differences between RLB and ESPB based on current clinical and anatomical reports. We also propose the clinical indication and discuss the differences, clinical outcomes, and anatomical mechanisms of the techniques.

Figures

Figure 1
Figure 1
The injection point of the retrolaminar block and erector spinae plane block. The needle used for retrolaminar block (RLB) is inserted 1 cm lateral to the spinous process and local anesthetic is injected on the lamina. The needle used for erector spinae plane block (ESPB) is inserted 2-3 cm lateral to the spinous process and local anesthetic is injected on the transversus process. In both RLB and ESPB, the needle is not required to penetrate the superior costotransverse ligament.
Figure 2
Figure 2
Ultrasound images of retrolaminar block and erector spinae plane block. The sagittal plane with a linear ultrasound probe allows for visualization of the laminae or transversus process. The insertion points for retrolaminar block (RLB) and erector spinae plane block (ESPB) are similar. The transversus process is more superficial than the lamina in the ultrasound image, and the injection point for ESPB is close to the pleura.
Figure 3
Figure 3
The distribution pathway of local anesthetics in retrolaminar block and erector spinae plane block. The paravertebral block (PVB) pathway involves both the ventral and the dorsal spinal rami and showed similar mechanism with PVB. The lateral pathway involves the lateral cutaneous branch and small branches of intercostal nerves. This pathway was similar to the mechanism underlying interfascial plane block.

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Source: PubMed

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