PMC6329236_01
(a) High-frequency probe placed 3 cm lateral to T5 spinous process, (b) T - Trapezius, RM - Rhomboid major, ES - Erector spinae, TP - Transverse process, and P - Pleura
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F1
T5 spinous process was palpated and marked; another point 3 cm lateral to the midline was also marked after cleaning and draping [Figure 1a]. The three muscles of the back were identified (from superficial to deep) as trapezius, rhomboid major, and erector spinae [Figure 1b] overlying the acoustic shadow of the transverse process.
(a) Needle entry in craniocaudal direction, (b) Local anesthetic deposit below Erector spinae muscle * Local anesthetic
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F2
A 22G, 10 cm echogenic needle (Pajunk Sonoplex, Geisingen, Germany) was then inserted "in-plane" from cranial to caudal direction [Figure 2a], to make contact with the transverse process. A volume of 1-2 ml of normal saline was injected to hydrodissect the plane following which 20 ml of ropivacaine (0.375%) was deposited lifting the erector spinae muscle off the transverse process [Figure 2b].