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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23870    [Epub ahead of print]
Published online April 15, 2024.
Retro superior costotransverse ligament space block as an effective analgesia after laparoscopic gastrectomy: a case report
Youngin Lee1,2, Seunguk Bang1,2, Jihyun Chung1,2, Jookyoung Moon1,2
1Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, 34943, Republic of Korea
2Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Corresponding author:  Seunguk Bang, Tel: 82-42-220-9046, Fax: 0504-419-6077, 
Email: seungukb@naver.com
Received: 30 November 2023   • Revised: 25 January 2024   • Accepted: 5 February 2024
The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade.
We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period.
The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.
Key Words: Anesthesia; Local anesthetic; Nerve block; Paraspinal muscle; Postoperative pain; Thoracic vertebrae; Ultrasonography


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