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Schematic diagram. Local anesthetic, which is injected deep to the erector spinae muscle, spreads to the thoracic paravertebral and intercostal space through the fenestrations in the costotransverse ligament and costotransverse foramen. Image adapted and used with permission from Journal of Korean Medical Science.[9] ESM = erector spinae muscle, TM = trapezius muscle, TP = transverse process.
