{
  "abstract": "Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims The erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique for thoracoabdominal procedures. Its role in enhanced recovery after surgery (ERAS) pathways for open gynecologic surgeries remains under investigation. Traditional analgesic techniques such as transversus abdominis plane (TAP) blocks primarily target somatic pain, while the ESPB may offer broader coverage, including visceral pain, by engaging thoracolumbar sympathetic fibers. This cadaveric study aimed to evaluate the anatomical spread of local anesthetic from ESPB injections and its implications for sensory blockade of the abdominal wall.Methods A fresh, non-embalmed adult male cadaver was used. Two ESPBs were performed: a single-shot 40 mL injection at the T8 level on the left side and a catheter-based 40 mL injection at the T4 level on the right. Both injectates included blue dye and radiopaque contrast. Real-time fluoroscopy was used during injection to assess cephalocaudal spread, followed by anatomical dissection to evaluate dye distribution across neural and fascial structures.Results Fluoroscopy showed extensive vertical spread of contrast. ( Figure 1) Dissection revealed dye diffusion from T3 to T12 on the left and from T1 to T8 on the right, tracking anterior and deep to the erector spinae muscles. (Figure 2A) Injectate extended into the paravertebral and intercostal spaces. (Figure 2B) There was no evidence of dye in the dorsal root ganglion, epidural space, or anterior sympathetic chain.Abstract P126 Figure 1(A) Right sided catheter in place at the T4 level; (B) Radiopaque contrast spread from T1 to T8 in both a cephalocaudal and mediolateral fashionAbstract P126 Figure 2(A) Extent of cephalad to caudal dye spread. Left single shot, 40 mL injection at T8 level: spread from T3 to T12, with lateral spread along iliocostalis muscle even at the lower back. Right catheter bolus, 40 mL injection at T4 level: spread from T1 to T8, but further down the back, the dye mostly stayed within the medial erector spinae muscles; (B) Laminectomy performed to reveal and examine interlaminar structures. No dural sac staining seen, and epidural space was unaffected. Paravertebral staining with both left and right injections, and intercostal staining also observed in each caseConclusions Cadaveric studies have been done for the ESPB with varying results. Our own large-volume injectate and catheter injection study is in-line with studies that demonstrated extensive dermatomal coverage as well as paravertebral spread. This suggests potential coverage of the thoracolumbar sympathetic nerves responsible for both abdominal wall somatic and visceral sensations, which supports the feasibility of ESPB as an adjunct for postoperative analgesia in open gynecologic procedures, warranting further clinical investigation.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Edward Tsai"
    },
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Javier Lasala"
    },
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Keyuri Popat"
    },
    {
      "affiliations": [
        "Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Gabriel Mena"
    }
  ],
  "title": "P126 Cadaveric evaluation of local anesthetic spread in the erector spinae plane for abdominal wall sensory blockade in open gynecologic surgery",
  "uid": "81dda365-0f46-5fa2-a534-a542962fb54a"
}