Erector spinae plane block at the thoracolumbar spine: a canine cadaveric study

Published:August 02, 2022DOI:



      To investigate the injectate spread and nerve staining of ultrasound-guided erector spinae plane (ESP) injections at the thoracolumbar spine in canine cadavers.

      Study design

      Prospective, randomized, descriptive, anatomic study.


      A total of 15 canine cadavers.


      The location of the medial and lateral branches of the dorsal branches of the spinal nerves (DBSN) from the tenth thoracic (T10) to the third lumbar vertebra (L3) were identified by dissection of three cadavers. ESP injections of dye (0.5 mL kg–1) were performed in seven cadavers using as landmarks the T12 transverse process (ESPTp) on one side and the lateral aspect of the T12 mammillary process (ESPMp) on the opposite side. Additionally, five cadavers were injected with dye (0.5 mL kg–1) bilaterally on the lateral aspect of the L2 mammillary process (ESPMp_L2). Nerve staining effect was analyzed after gross anatomic dissections. The number of stained nerves was analyzed using the Mann–Whitney U test.


      Gross anatomic dissections showed that the medial and lateral branches of the DBSN change their path in relation to the epaxial muscles caudal to T11. Approaches ESPTp and ESPMp at T12 stained 2 (0–2) and 3 (2–4) medial (p = 0.01) and 3 (3–4) and 2 (0–2) lateral (p = 0.03) branches, respectively. Injection ESPMp_L2 stained 3 (2–4) medial and 2 (0–3) lateral branches. Injections ESPMp and ESPMp_L2 produced a preferential cranial spread from the injection site. No ventral branches of the spinal nerves were stained with either technique.

      Conclusions and clinical relevance

      These results suggest that the mammillary process should be used as anatomic landmark to perform ultrasound-guided ESP blocks in the thoracolumbar spine caudal to T11 when targeting the medial branches of the DBSN. Injections should be performed one spinal segment caudal to the level intended to desensitize.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Veterinary Anaesthesia and Analgesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Aponte A.
        • Sala-Blanch X.
        • Prats-Galino A.
        • et al.
        Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study.
        Can J Anaesth. 2019; 66: 886-893
        • Bailey C.S.
        • Kitchell R.L.
        • Haghighi S.S.
        • Johnson R.D.
        Cutaneous innervation of the thorax and abdomen of the dog.
        Am J Vet Res. 1984; 45: 1689-1698
        • Chin K.J.
        • Lirk P.
        • Hollmann M.W.
        • Schwarz S.K.W.
        Mechanisms of action of fascial plane blocks: a narrative review.
        Reg Anesth Pain Med. 2021; 46: 618-628
        • Dautzenberg K.H.W.
        • Zegers M.J.
        • Bleeker C.P.
        • et al.
        Unpredictable injectate spread of the erector spinae plane block in human cadavers.
        Anesth Analg. 2019; 129: e163-e166
        • Ferreira T.H.
        • St James M.
        • Schroeder C.A.
        • et al.
        Description of an ultrasound-guided erector spinae plane block and the spread of dye in dog cadavers.
        Vet Anaesth Analg. 2019; 46: 516-522
        • Forero M.
        • Adhikary S.D.
        • Lopez H.
        • et al.
        The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain.
        Reg Anesth Pain Med. 2016; 41: 621-627
        • Hermanson J.W.
        Spinal nerves.
        in: Evans H.E. de Lahunta A. Miller’s Anatomy of the Dog. 4th edn. Saunders Elsevier, USA2013: 185-280
        • Ivanusic J.
        • Konishi Y.
        • Barrington M.J.
        A cadaveric study investigating the mechanism of action of erector spinae blockade.
        Reg Anesth Pain Med. 2018; 43: 567-571
        • Jeffery N.D.
        • Levine J.M.
        • Olby N.J.
        • Stein V.M.
        Intervertebral disk degeneration in dogs: consequences, diagnosis, treatment, and future directions.
        J Vet Intern Med. 2013; 27: 1318-1333
        • Krishna S.N.
        • Chauhan S.
        • Bhoi D.
        • et al.
        Bilateral erector spinae plane block for acute post-surgical pain in adult cardiac surgical patients: a randomized controlled trial.
        J Cardiothorac Vasc Anesth. 2019; 33: 368-375
        • Medina-Serra R.
        • Foster A.
        • Plested M.
        • et al.
        Lumbar erector spinae plane block: an anatomical and dye distribution evaluation of two ultrasound-guided approaches in canine cadavers.
        Vet Anaesth Analg. 2021; 48: 125-133
        • Medina-Serra R.
        • Cavalcanti M.
        • Portela D.A.
        • et al.
        Transversal approach to the canine lumbar erector spinae plane block: returning to the dissecting room.
        Vet Anaesth Analg. 2021; 48: 811-813
        • Otero P.E.
        • Fuensalida S.E.
        • Russo P.C.
        • et al.
        Mechanism of action of the erector spinae plane block: distribution of dye in a porcine model.
        Reg Anesth Pain Med. 2020; 45: 198-203
        • Portela D.A.
        • Campoy L.
        • Otero P.E.
        • et al.
        Ultrasound-guided thoracic paravertebral injection in dogs: a cadaveric study.
        Vet Anaesth Analg. 2017; 44: 636-645
        • Portela D.A.
        • Castro D.
        • Romano M.
        • et al.
        Ultrasound-guided erector spinae plane block in canine cadavers: relevant anatomy and injectate distribution.
        Vet Anaesth Analg. 2020; 47: 229-237
        • Portela D.A.
        • Romano M.
        • Zamora G.A.
        • et al.
        The effect of erector spinae plane block on perioperative analgesic consumption and complications in dogs undergoing hemilaminectomy surgery: a retrospective cohort study.
        Vet Anaesth Analg. 2021; 48: 116-124
        • Tomaszewski K.A.
        • Henry B.M.
        • Kumar Ramakrishnan P.
        • et al.
        Development of the anatomical quality assurance (AQUA) checklist: guidelines for reporting original anatomical studies.
        Clin Anat. 2017; 30: 14-20
        • Tulgar S.
        • Senturk O.
        Ultrasound guided erector spinae plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty.
        J Clin Anesth. 2018; 44: 68
        • Zannin D.
        • Isaka L.J.
        • Pereira R.H.
        • Mencalha R.
        Opioid-free total intravenous anesthesia with bilateral ultrasound-guided erector spinae plane block for perioperative pain control in a dog undergoing dorsal hemilaminectomy.
        Vet Anaesth Analg. 2020; 47: 728-731