ERECTOR SPINAE

PLANE BLOCK
16.1.2020
CONTENTS
➤ Anatomy
➤ Mechanism
➤ Technique
➤ Application
➤ Benefit
➤ Complication
➤ Future research
Anatomy of Erector spinae
FIRST CASE REPORT
OF ESP BLOCK
➤ Forero (2016) - The Erector
Spinae Plane Block: A Novel
Analgesic Technique in Thoracic
Neuropathic Pain.
➤ Presented 4 cases including those
with metastatic rib pain and
multiple rib fracture
➤ Both single-shot and catheter
techniques reduced pain scores
➤ Correlation with CT and
cadaveric study
MECHANISM
➤ Cadaveric studies
➤ Yang 2018: 20mL injectate to T5
cause craniocaudal retrolaminar
spread with some paravertebral
spread (median 3.5 spinal level)
➤ Choi 2019: no PV spread with 10mL
but consistent spread with 30mL to
spinal nerves at intervertebral
foramen (median 3 levels) ± epidural
±sympathetic chain
➤ De Lara Gondález 2019: 20mL to L4
causes L2-L5 ESP spread ± anterior
to TP (67%) ± Extensive PV spread
(16%)
TECHNI
QUE
 POTENTIAL
BENEFIT
➤ Easier to perform
➤ Somatic and visceral
block
➤ Multi-level block
➤ Safer in anti-
coagulated patient
REPORTED
COMPLICATIONS
➤ Pneumothorax

➤ Limb weakness
FUTURE RESEARCH
➤ Need of more high quality RCTs
➤ Need of meta-analysis and systemic review
➤ Need of study in different population (e.g. paediatrics)
➤ Need of RCT to determine the efficacy of lumbar ESP at different
level of injections and volume of injectate
➤ Use of adjunct (e.g steroid/opioid/dexmedetomidine) along with
local anaesthetic in ESP block
CONCLUSION?
➤ ESP block is a novel regional
technique that involves in
interfascial injection between tip
of transverse process and erector
spinae muscle
➤ The mechanism is still elusive, but
spread to paravertebral space and
spinal nerve may contribute to its
efficacy
➤ Wide range of application is
potentially attractive, but requires
further research and high quality
studies to define its utilisation

… つづく
REFERENCE
1. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Forero M
et al, Reg Anesth Pain Med. 2016 Sep-Oct;41(5):621-7.
2. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane
blocks in the thoracic region: a cadaveric study. Yang HM et al. Anaesthesia. 2018 Oct;73(10):1244-1250.
3. Influence of injectate volume on paravertebral spread in erector spinae plane block: An endoscopic and
anatomical evaluation. Choi YJ et al. PLoS One. 2019 Oct 28;14(10)
4. https://app.nysora.com/courses/erector-spinae-plane-block/lessons/landmarks-patient-position-3/
5. Curb Your Enthusiasm: Erector Spinae Plane Block—‘Because It Is Easy’ Is Not a Good Reason to Do It!
Uppal V et al, ASRA news Nov 2019 from
https://www.asra.com/asra-news/article/213/curb-your-enthusiasm-erector-spinae-plan
6. Continuous Erector Spinae Plane Block as an Effective Analgesic Option in Anticoagulated Patients
After Left Ventricular Assist Device Implantation: A Case Series. Adhikary SD et al. J Cardiothorac Vasc
Anesth. 2019 Apr;33(4):1063-1067
7. Pneumothorax after the erector spinae plane block. Ueshima et al. Journal of clinical anaesthesia. Vol
48, Aug 2018. P. 12
8. Ultrasound guided erector spinae plane block as a cause of unintended motor block. Selvi O et al. Rev
Esp Anestesiol Reanim. 2018 Dec;65(10):589-592.