ESB technique
Standard patient monitoring included ECG, non-invasive blood pressure measurement every 5 min, and pulse oximetry. An intravenous cannula was inserted, and resuscitation equipment was kept nearby. The patient was positioned prone. Using fluoroscopic guidance, the transverse process of the T4 vertebra was identified. The target site was sterilized and anesthetized with 3 ml of 2% lidocaine. A 25-gauge spinal needle was inserted to the level of the T4 transverse process. After withdrawing the needle by a distance of 2–3 mm and confirming that it was not intravascular through suction, either 20 ml or 30 ml of the solution was injected. Subsequently, another fluoroscopic antero-posterior photo was taken to determine the number of levels reached by the solution in each group (Figs. Fluoroscopic photo, arrows show the level of spread in the 20 ml ESB group from the T2 to T6 levels and the needle was at the transverse process of T4Fluoroscopic photo, arrows show the level of spread in the 30 ml ESB group from the C8 to T6 levels and the needle was at the transverse process of T4