Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers

Objectives To describe a technique to perform an ultrasound-guided erector spinae plane (ESP) block and determine the distribution and potential complications after injection of two volumes of methylene blue in dog cadavers. Study design Prospective experimental cadaveric study. Animals A total of eight dog cadavers weighing 9.3 +/- 1.9 kg. Methods Ultrasound-guided injections dorsal to the transverse process and ventral to the erector spinae muscles aimed at the fifth thoracic transverse process were performed bilaterally in each dog using 0.5 and 1.0 mL kg(-1) dye solution [low volume (LV) and high volume (HV) treatments, respectively]. Treatments were randomly assigned to the right or left side of each dog, resulting in a total of 16 injections. Anatomical dissections determined dye spread characteristics, including epaxial muscles spread, staining of spinal nerves, dorsal rami, ventral rami (intercostal nerves) and sympathetic trunk spread. Staining indicating potential complications (epidural, mediastinal and intrapleural spread) was recorded. Results There was complete staining of at least one dorsal ramus following all injections. A more extensive spread was observed along the muscles in the HV compared with LV (p = 0.036). No significant difference between multisegmental dorsal rami spread (six out of eight injections in each treatment) was noted. Out of 16 injections, one in LV treatment resulted in multisegmental spinal nerve staining and one in HV treatment resulted in ventral ramus intercostal nerve) staining. Use of anatomic landmarks resulted in inaccurate identification of the fifth transverse process in at least six out of 16 injections (38%). No sympathetic trunk, epidural, mediastinal or intrapleural staining was observed. Conclusions and clinical relevance Ultrasound-guided ESP injections resulted in extensive staining along the epaxial muscles, as well as staining of the dorsal rami in all dogs. The incidence of dorsal rami mutisegmental spread was the same in both treatments.