Erector spinae plane block for pain management
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The document describes the development and application of the Erector Spinae Plane Block (ESB) for treating severe thoracic neuropathic pain, initially introduced by Mauricio Forero in 2016. Various case reports highlight its effectiveness in conditions affecting cervical, thoracic, abdominal, and pelvic areas, showing significant pain relief and sensory blockade. The ESB is noted as a successful alternative to thoracic epidural anesthesia with lower risks of serious complications, though further research is needed for standardization and comparison to other regional techniques.
Erector spinae plane block for pain management
- 1. By Mohamed Abuelnaga Lecturer Of Anesthesia Suez Canal University
- 2. In 2016 Erector spinae plane block (ESB) was first described by Mauricio Forero, et al as an ultrasound-guided interfascial plane block to successfully treat severe thoracic neuropathic pain. In 2017 and 2018, ESB has been described in case reports in multiple clinical scenarios including cervical ,thoracic ,abdominal and pelvic pain conditions .
- 10. 1 September 2017 1 September 2017
- 11. 23 October 2017
- 13. December 1, 2017 cases-anesthesia- analgesia.org
- 28. Described by Forero et al, 1st approach: Patient complaint: burning and stabbing neuropathic pain of 10/10 severity on the NRS radiating from his spine into the anterior chest wall, mainly at T5 and extending several dermatomes inferiorly Position :sitting position Level :transverse process of T5 US probe: high frequency linear
- 29. Plane :parasagittal 3 cm lateral to the midline Land marks :Three muscles were identified superficial to the hyperechoic transverse process shadow as follows: trapezius, rhomboid major, and erector spinae Needle :8-cm 22-gauge block needle inserted in a cephalad to caudad direction Drug :20 mL of 0.25% bupivacaine injected in the interfascial plane between rhomboid major and erector spinae muscles
- 32. Results : Within several minutes pain had diminished significantly. NRS became 0/10 over 2 hours There was an area of diminished sensation to pinprick extending from T2 to T9 in a cephalo-caudad direction, and from a line 3 cm lateral to the thoracic spine to the midclavicular line in an anterior–posterior direction . The axilla and medial aspect of the upper arm also exhibited sensory blockade.
- 37.
- 42. Ingection at T7 TP Sensory loss between C5 and L2
- 43. Injection at T2/3 TP analgesic range from C3 to T5
- 45. 20 ml Injection at T3 TP
- 47. 8 June 2018
- 48. 15 June 2018
- 49. July 25, 2018: Annals of Cardiac Anaesthesia
- 50. Methods:29.7 mL of 0.25% bupivacaine with 0.3 mL gadolinium was injected. The MRI images were taken 45 and 90 min after injection to evaluate potential further spread over time
- 52. 1-These MRI images suggest that ESP mechanism of action is likely linked to the transforaminal and epidural spread which may be a potential advantage over other thoracic interfascial plane blocks 2-Further MRI studies with a larger sample size and a systematic approach to correlate clinical presentation and spread of contrast are required to better elucidate the more detailed anatomical mechanisms of the ESPB
- 53. Regional Anesthesia and Pain Medicine , August 2018
- 59. 1-Single-injection retrolaminar and ESP blocks in fresh cadavers both produce epidural and neural foraminal spread and thus can be expected to have clinical effects similar to thoracic paravertebral blockade. 2-The ESP block exhibits additional intercostal spread that may contribute to wider analgesic coverage than the retrolaminar block.
- 60. ESP block is successful alternative technique to thoracic epidural anesthesia with a minimal risk of serious complications such as epidural hematoma or epidural abscess. further research is still required to standardize doses and concentration of local anesthetics and to compare ESP block with other regional techniques.