The anatomical spread of a simulated ultrasound-guided erector spinae fascial plane block in the cervical region in neonatal cadavers observed through cone beam computed tomography scans

Abstract

Background: The erector spinae plane block (ESPB), a novel anaesthetic technique, has been shown to be a safer alternative to neuraxial and paravertebral blocks in adults. The exact mechanism of action of the ESPB in the cervical region – performed at the C6 and C7 vertebral levels – remains unclear in both adult and paediatric patients.
Aim: The aim of this study was to determine the spread of a simulated cervical ESPB in a neonatal sample and to translate the clinical relevance of the anatomical findings for anaesthesia providers.
Setting: Study was conducted at the Department of Anatomy, Faculty of Health Sciences, University of Pretoria, South Africa.
Methods: Nine fresh-frozen low-normal birth weight neonatal cadavers were injected with contrast medium (0.1 mL/kg) at both C6 (anterior tubercle of the transverse process) and C7 (transverse process) vertebral levels. The ultrasound-guided injections were done with the cadavers in a prone position, utilising a 5 cm 22G Tuohy needle. Following the injections, cone-beam computed tomography scans were performed using the Planmeca G7 scanner, operated with Romexis software (version 6.4.5.136; Planmeca, Helsinki, Finland).
Results: Twelve simulated blocks were performed; seven at C6 and five at C7. The contrast medium spread most consistently between the C5 and C7 levels when performing the simulation at the C6 vertebral level and between C6 and T1 when performing the simulation at the C7 vertebral level.
Conclusion: The study results suggest that the cervical ESPB may be a promising regional anaesthesia technique for neonates and infants undergoing procedures involving the cervical spine or upper limbs.
Contribution: This study offers valuable anatomical insights into the cervical ESPB in a neonatal cadaveric sample, demonstrating the consistent spread of the contrast medium across the C5–C7 dermatomes, with additional, less consistent spread observed from C2 to T1.