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Erector Spinae Plane Block
Rafael Vazquez, MD; Nicole Z. Spence, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Synonyms

              • Erector spinae plane block (ESPB)
            • Definitions

              • Blockade of surrounding spinal dorsal rami, lateral cutaneous branches of intercostal nerves, and usually spinal ventral rami near injection site
                • Blockade of somatic dermatomes of anterior and posterior chest and abdominal wall
                • Ventral rami spread results in visceral analgesia clinically observed
                • Injection at lumbar levels result in analgesia of iliac crest, hip, and lower extremity
              • Single-shot results in analgesia for 4-6 hours
                • Catheter can provide analgesia for > 6 hours
              • Can be performed with ultrasound or CT imaging modalities

            PREPROCEDURE

            • Indications

              • Contraindications

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Adhikary SD et al: The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 74(5):585-93, 2019
                                      2. Baca Q et al: Erector spinae plane block for pediatric palliative care. Paediatr Anaesth. 29(4):386-7, 2019
                                      3. Balaban O et al: Lumbar erector spinae plane catheterization for continuous postoperative analgesia in total knee arthroplasty: a case report. J Clin Anesth. 55:138-9, 2019
                                      4. De Cassai A et al: Old approach for a new indication: shamrock sign for ESP block. Reg Anesth Pain Med. ePub, 2019
                                      5. Gürkan Y et al: Iliac crest bone graft donor site analgesia: a new indication for erector spinae plane block. Can J Anaesth. 66(3):338-9, 2019
                                      6. Hamilton DL: Reducing the risk of pneumothorax following erector spinae plane block. J Clin Anesth. 56:3, 2019
                                      7. Noss C et al: Erector spinae plane block for open-heart surgery: a potential tool for improved analgesia. J Cardiothorac Vasc Anesth. 33(2):376-7, 2019
                                      8. Santonastaso DP et al: Ultrasound guided erector spinae plane block for open partial nephrectomy: only an alternative? J Clin Anesth. 56:55-6, 2019
                                      9. Tsui BCH et al: The erector spinae plane (ESP) block: a pooled review of 242 cases. J Clin Anesth. 53:29-34, 2019
                                      10. Tulgar S et al: Ultrasound guided erector spinae plane block relieves lower cervical and interscapular myofascial pain, a new indication. J Clin Anesth. 53:74, 2019
                                      11. Xu JL et al: Ultrasound-guided erector spinae plane block using long-range multi-orifice catheter for chest wall pain management in patients with multiple rib fractures. Am Surg. 85(1):e6-e8, 2019
                                      12. Ahiskalioglu A et al: (MS 19311) Ultrasound guided erector spinae plane block as a safe and effective method to treat herpes zoster pain. Am J Emerg Med. 37(6):1192-4, 2018
                                      13. Alici HA et al: High volume single injection lumbar erector spinae plane block provides effective analgesia for lower extremity herpes zoster. J Clin Anesth. 54:136-7, 2018
                                      14. De la Cuadra-Fontaine JC et al: Continuous erector spinae plane block for thoracic surgery in a pediatric patient. Paediatr Anaesth. 28(1):74-5, 2018
                                      15. Finneran JJ 4th et al: Erector spinae plane blocks provide analgesia for breast and axillary surgery: a series of 3 cases. Reg Anesth Pain Med. 43(1):101-2, 2018
                                      16. Hacibeyoglu G et al: USG guided bilateral erector spinae plane block is an effective and safe postoperative analgesia method for living donor liver transplantation. J Clin Anesth. 49:36-7, 2018
                                      17. Ince I et al: Ultrasound-guided erector spinae plane block for acute herpes zoster pain management: is it safe? Am J Emerg Med. 37(6):1192, 2018
                                      18. Ince I et al: Erector spinae plane block catheter insertion under ultrasound guidance for thoracic surgery: case series of three patients. Eurasian J Med. 50(3):204-6, 2018
                                      19. Ivanusic J et al: A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 43(6):567-71, 2018
                                      20. Kadam VR et al: Use of erector spinae plane block in open abdominal surgery and cancer pain. J Anaesthesiol Clin Pharmacol. 34(4):564-7, 2018
                                      21. Kim E et al: The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J (Engl). 131(15):1877-8, 2018
                                      22. Kose HC et al: Lumbar versus thoracic erector spinae plane block: similar nomenclature, different mechanism of action. J Clin Anesth. 48:1, 2018
                                      23. Luftig J et al: Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med. 36(8):1391-6, 2018
                                      24. Macaire P et al: Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery-a patient-matched, controlled before-and-after study. J Cardiothorac Vasc Anesth. 33(6):1659-67, 2018
                                      25. Melvin JP et al: Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 65(9):1057-65, 2018
                                      26. Vidal E et al: Erector spinae plane block: a cadaver study to determine its mechanism of action. Rev Esp Anestesiol Reanim. 65(9):514-9, 2018
                                      27. Forero M et al: The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 41(5):621-7, 2016
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Erector spinae plane block (ESPB)
                                                • Definitions

                                                  • Blockade of surrounding spinal dorsal rami, lateral cutaneous branches of intercostal nerves, and usually spinal ventral rami near injection site
                                                    • Blockade of somatic dermatomes of anterior and posterior chest and abdominal wall
                                                    • Ventral rami spread results in visceral analgesia clinically observed
                                                    • Injection at lumbar levels result in analgesia of iliac crest, hip, and lower extremity
                                                  • Single-shot results in analgesia for 4-6 hours
                                                    • Catheter can provide analgesia for > 6 hours
                                                  • Can be performed with ultrasound or CT imaging modalities

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things to Do

                                                                    • Things to Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Adhikary SD et al: The effect of erector spinae plane block on respiratory and analgesic outcomes in multiple rib fractures: a retrospective cohort study. Anaesthesia. 74(5):585-93, 2019
                                                                          2. Baca Q et al: Erector spinae plane block for pediatric palliative care. Paediatr Anaesth. 29(4):386-7, 2019
                                                                          3. Balaban O et al: Lumbar erector spinae plane catheterization for continuous postoperative analgesia in total knee arthroplasty: a case report. J Clin Anesth. 55:138-9, 2019
                                                                          4. De Cassai A et al: Old approach for a new indication: shamrock sign for ESP block. Reg Anesth Pain Med. ePub, 2019
                                                                          5. Gürkan Y et al: Iliac crest bone graft donor site analgesia: a new indication for erector spinae plane block. Can J Anaesth. 66(3):338-9, 2019
                                                                          6. Hamilton DL: Reducing the risk of pneumothorax following erector spinae plane block. J Clin Anesth. 56:3, 2019
                                                                          7. Noss C et al: Erector spinae plane block for open-heart surgery: a potential tool for improved analgesia. J Cardiothorac Vasc Anesth. 33(2):376-7, 2019
                                                                          8. Santonastaso DP et al: Ultrasound guided erector spinae plane block for open partial nephrectomy: only an alternative? J Clin Anesth. 56:55-6, 2019
                                                                          9. Tsui BCH et al: The erector spinae plane (ESP) block: a pooled review of 242 cases. J Clin Anesth. 53:29-34, 2019
                                                                          10. Tulgar S et al: Ultrasound guided erector spinae plane block relieves lower cervical and interscapular myofascial pain, a new indication. J Clin Anesth. 53:74, 2019
                                                                          11. Xu JL et al: Ultrasound-guided erector spinae plane block using long-range multi-orifice catheter for chest wall pain management in patients with multiple rib fractures. Am Surg. 85(1):e6-e8, 2019
                                                                          12. Ahiskalioglu A et al: (MS 19311) Ultrasound guided erector spinae plane block as a safe and effective method to treat herpes zoster pain. Am J Emerg Med. 37(6):1192-4, 2018
                                                                          13. Alici HA et al: High volume single injection lumbar erector spinae plane block provides effective analgesia for lower extremity herpes zoster. J Clin Anesth. 54:136-7, 2018
                                                                          14. De la Cuadra-Fontaine JC et al: Continuous erector spinae plane block for thoracic surgery in a pediatric patient. Paediatr Anaesth. 28(1):74-5, 2018
                                                                          15. Finneran JJ 4th et al: Erector spinae plane blocks provide analgesia for breast and axillary surgery: a series of 3 cases. Reg Anesth Pain Med. 43(1):101-2, 2018
                                                                          16. Hacibeyoglu G et al: USG guided bilateral erector spinae plane block is an effective and safe postoperative analgesia method for living donor liver transplantation. J Clin Anesth. 49:36-7, 2018
                                                                          17. Ince I et al: Ultrasound-guided erector spinae plane block for acute herpes zoster pain management: is it safe? Am J Emerg Med. 37(6):1192, 2018
                                                                          18. Ince I et al: Erector spinae plane block catheter insertion under ultrasound guidance for thoracic surgery: case series of three patients. Eurasian J Med. 50(3):204-6, 2018
                                                                          19. Ivanusic J et al: A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 43(6):567-71, 2018
                                                                          20. Kadam VR et al: Use of erector spinae plane block in open abdominal surgery and cancer pain. J Anaesthesiol Clin Pharmacol. 34(4):564-7, 2018
                                                                          21. Kim E et al: The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J (Engl). 131(15):1877-8, 2018
                                                                          22. Kose HC et al: Lumbar versus thoracic erector spinae plane block: similar nomenclature, different mechanism of action. J Clin Anesth. 48:1, 2018
                                                                          23. Luftig J et al: Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block. Am J Emerg Med. 36(8):1391-6, 2018
                                                                          24. Macaire P et al: Ultrasound-guided continuous thoracic erector spinae plane block within an enhanced recovery program is associated with decreased opioid consumption and improved patient postoperative rehabilitation after open cardiac surgery-a patient-matched, controlled before-and-after study. J Cardiothorac Vasc Anesth. 33(6):1659-67, 2018
                                                                          25. Melvin JP et al: Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 65(9):1057-65, 2018
                                                                          26. Vidal E et al: Erector spinae plane block: a cadaver study to determine its mechanism of action. Rev Esp Anestesiol Reanim. 65(9):514-9, 2018
                                                                          27. Forero M et al: The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 41(5):621-7, 2016