Reply to letter to the editor: Inter-transverse process blocks: caution about difference in methods

Article information

Anesth Pain Med. 2024;19(1):68-69
Publication date (electronic) : 2024 January 31
doi :
Department of Anesthesiology, Nara Medical University, Nara, Japan
Corresponding author: Nobuhiro Tanaka, M.D., Ph.D. Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan Tel: 81-744-29-8902 Fax: 81-744-23-9741 E-mail:
Received 2023 September 21; Accepted 2023 October 16.

AUTHORS’ REPLY: We thank Dr. Sethuraman for his interest in our case report [1]. We want to reply because we believe that organizing the concept of the intertransverse process block (ITPB) and discussing it in Anesthesia and Pain Medicine will help readers better understand the process.

In determining the nomenclature of regional anesthesia, the ITPB concept encompasses the multiple injection costotransverse block, the subtransverse process interligamentary plane block, the costotransverse foramen block (CTFB), and the midpoint transverse process to pleura block (MTPB) [2].

Please note that we performed a ‘costotransverse foramen block’ in case 1 [3], which is a faithful reproduction of the report by Shibata et al., and we did not perform a ‘multiple injection costotransverse block.’ In fact, there was a discussion between Dr. Shibata’s group and Dr. Nielson’s group regarding with the needle direction [4]; please refer to that as well. We performed CTFB in support of the opinion of Dr. Shibata et al that caudal to cephalad needle direction minimizes the risk of neurovascular injury. Therefore, we believe that the needle direction was correct.

We believe this point was caused by the confusion of nerve blocks with similar names and concepts, and that it is clear that procedures of ITPB need to be standardized.

Another point of interest in his letter was the representation of CTFB and MTPB as interfascial plane blocks. ITPB targets the tissue complex posterior to the superior costotransverse ligament (SCTL) [5] and is considered distinctly different from blocks that target the fascial plane, such as the erector spinae plane block.

This ‘intertransverse tissue complex’ comprises the intertransverse ligament, fatty tissue, the intertransverse and lavatores costarum muscles, and the SCTL. Different from interfascial plane blocks, the feature of achieving analgesic efficacy by administration of local anesthetics into tissue complexes closer to the pathway to the paravertebral space is unique to ITPB.

In summary, the concept of ITPB has been established, but standardization of the technique is needed, as well as clarification of the mechanism and recommendations for appropriate clinical indications.





No potential conflict of interest relevant to this article was reported.


Writing - original draft: Nobuhiro Tanaka. Writing - review & editing: Yuma Kadoya, Takanori Suzuka, Masahiko Kawaguchi.


1. Sethuraman RM. Inter-transverse process blocks: caution about difference in methods. Anesth Pain Med (Seoul) 2023;18:325–6.
2. El-Boghdadly K, Wolmarans M, Stengel AD, Albrecht E, Chin KJ, Elsharkawy H, et al. Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of abdominal wall, paraspinal, and chest wall blocks. Reg Anesth Pain Med 2021;46:571–80.
3. Yamamoto Y, Tanaka N, Kadoya Y, Umehara M, Suzuka T, Kawaguchi M. Bolus intertransverse process block and continuous erector spinae plane block for perioperative analgesic management of video-assisted thoracoscopic surgery: three cases report. Anesth Pain Med (Seoul) 2023;18:198–203.
4. Kampitak W, Shibata Y. In response: new name, no novelty. Pain Physician 2020;23:E738–9.
5. Kim SH. Anatomical classification and clinical application of thoracic paraspinal blocks. Korean J Anesthesiol 2022;75:295–306.

Article information Continued