Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study

Although different injection locations for retrolaminar and erector spinae plane blocks have been described, the two procedures have a similar anatomical basis. In this cadaveric study we compared anatomical spread of dye in the thoracic region following these two procedures. Following randomisation, 10 retrolaminar blocks and 10 erector spinae plane blocks were performed on the left or right sides of 10 unembalmed cadavers. For each block, 20 ml of dye solution was injected at the T5 level. The back regions were dissected and the involvement of the thoracic spinal nerve was also investigated. Twenty blocks were successfully completed. A consistent vertical spread, with deep staining between the posterior surface of the vertebral laminae and the overlaying transversospinalis muscle was observed in all retrolaminar blocks. Moreover, most retrolaminar blocks were predominantly associated with fascial spreading in the intrinsic back muscles. With an erector spinae plane block, dye spread in a more lateral pattern than with retrolaminar block, and fascial spreading in the back muscles was also observed. The number of stained thoracic spinal nerves was greater with erector spinae plane blocks than with retrolaminar blocks; median 2.0 and 3.5, respectively. Regardless of technique, the main route of dye spread was through the superior costotransverse ligament to the ipsilateral paravertebral space. Although erector spinae plane blocks were associated with a slightly larger number of stained thoracic spinal nerves than retrolaminar blocks, both techniques were consistently associated with posterior spread of dye and with limited spread to the paravertebral space.

Comparative immunogenicity of HL-A antigens: a study in primiparas

A comparison of immunogenic strength among 23 HL-A antigens was made by studying HL-A antibodies formed in primiparous women. In this setting of single pregnancies, each one of the incompatible fetal antigens would have an equal opportunity (one gestational period) to sensitize the mother. Three hundred pairs of primiparous women and newborns were HL-A typed and the serum of each mother was tested for antibody activity against the child's lymphocytes. The test was positive in 24 instances; 19 sera were reactive with only one antigen of paternal origin, one serum was reactive with both antigens, and in four instances the children's incompatible antigens were identified. When the frequencies of different antibody specificities were statistically analysed, HL-A5 and W14 were found to be distinctly more immunogenic than the other antigens.