• Ji Yeong Kim, U-Young Lee, Do-Hyeong Kim, Dong Woo Han, Sang Hyun Kim, Yun Jeong Cho, Hyeyoon Jeong, Yun Ji Kim, A Rim Yang, and Hue Jung Park.
• Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
• Reg Anesth Pain Med. 2023 Sep 1.

BackgroundWe compared the spread of an injectate into the thoracic sympathetic chain resulting from a single-injection intertransverse process (ITP) block with that of a single-injection PV block at the T2 level.MethodsSixteen soft-embalmed cadavers were used. The right hemithorax was randomly allocated to receive either an ultrasound-guided single-injection ITP block or ultrasound-guided single-injection PV block at the T2 vertebral level, with the opposite block administered to the other side. Approximately 10 mL of latex dye solution was injected into each hemithorax using a random allocation technique. The presence of dye at the nerve root in the sympathetic chain and intercostal nerves at the injection and additional levels was examined by dissection.ResultsThe injectate spread into the T2 sympathetic ganglion on both ITP (11/16, 68.8%) and PV (16/16, 100%) blocks. The ITP block demonstrated greater uniformity of dye staining in both the dorsal rami and dorsal root ganglion, which contrasts with the less consistent staining outcomes of the PV block in these regions.ConclusionsAt the T2 level, we observed a lower efficacy of the ITP block for analgesic coverage of the sympathetic nerve. This suggested a potential preference by clinicians for the application of the T2 PV block over the ITP block, specifically for the management of sympathetically maintained pain in the upper extremities. In addition, our findings may hint at the potential advantages of the ITP block in specific clinical contexts where targeted nerve involvement, such as the medial branch block or dorsal root ganglion block, is sought.© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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