We performed an radiographic and anatomic study with the aim of clarifying the influence of volume of injectate on (A) craniocaudal spread and (B) spread to the ventral rami or other relevant structures/locations when performed via a lumbar ESP block. [...] A 21 ga 100 mm block needle (Sonoplex, Pajunk Medical Systems, Norcross, GA) was then inserted in-plane from the cephalad aspect of the transducer until the t ip was firmly apposed to the transverse process of L3, and 30 mL of solut ion injected in 10 mL increments. [...] Care was taken to document the precise disposit ion of the dye solution within and around the erector spinae muscle, the psoas major muscle, and the lumbar plexus. [...] This reinforces the findings of others who used 20 mL at the L4 level and found spread from L2-L5.(2) The degree of spread with 30 mL in the lumbar region (4 levels) is less than that the 6-9 levels seen following ESP inject ion in the thoracic region (previous thoracic cadaver model performed by the authors). [...] This may be due to anatomic factors such the larger size of the lumbar vertebrae, and/or fluid dynamics related to the thicker and less compliant erector spinae muscle in the lumbar region.
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