Lumbar erector spinae plane block: injection plane selection and the sequential strategy of the Tulgar approach

Le résumé fourni par la source

To the editor, We read with great interest the research letter by Kilicaslan and Ciftci et al., examining injection depth and volume in lumbar erector spinae plane (ESP) block in a cadaveric model.1 The authors compared the classical injection between the transverse process and the erector spinae muscle with a deeper approach beyond the intertransverse ligament adjacent to the psoas muscle (PM). While superficial injection remained largely posterior to the transverse process, the deeper injection extended to the lumbar nerve roots at low volumes and reached the deep pelvic compartment (S3–S4) with 40 mL. The authors propose naming the deeper technique as “deep lumbar ESP block” or “lumbar intertransverse process block” to distinguish it from the classical approach. However, it should be emphasized that the anatomical target described for this deeper approach corresponds to the deep component of the Tulgar approach,2 in which injection is initially performed between the transverse process and the ESM, followed by controlled advancement beyond the intertransverse ligament toward a plane immediately posterior to the PM, with confirmation by PM tenting. In this context, what is presented as a distinct deeper block represents a component of the sequential injection strategy previously described in the Tulgar approach rather than an entirely separate technique.3

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.