Five minutes after the administration of the bilateral erector spinae block (ESP), the VAS scale was 6/10, and after 10 minutes, 2/10. This enabled the patient to comfortably adopt a decubitus prone position and raise the upper extremities to perform the MRI. The study was conducted uneventfully. At the end of the procedure, the patient expressed absence of pain. Two hours after the end of the procedure, the patient was discharged to the postanesthesia care unit. The case was followed and the patient submitted his informed consent to report his case. Two weeks later, during a personal interview, the patient-rated VAS score was 3 to 4/10 at rest and as 5/10 during movement, and expressed his gratitude for his remarkable improvement.
The first reference to ESP block was in 2016 by the Colombian anesthesiologist Forero et al2, at McMaster University. An intrafascial US-guided block was administered between the major rhomboid muscle and the erector spinae, 3 cm lateral to the mid-line, at the level of the T5 transverse process in 4 patients (2 with refractory neuropathic pain receiving conventional therapy and 2 as postoperative chest surgery analgesia). A total volume of 20 mL of local anesthetic was used, with a cephalocaudal distribution through the anterior and posterior hemithorax. The block was highly effective for pain control. The suggestion by Forero et al2 is to administer the profound ESP block to the spinal erector muscle, using the transverse process of the vertebra as sonography marker; the proximity to the intervertebral foramen allows for irrigation of the dorsal and the ventral branches of the thoracic nerves. The ESP block has been reported as rescue therapy in case of failed epidural analgesia in chest surgery and analgesia in breast surgery3,4; as multimodal postoperative analgesia in pediatric patients,5,6 and in chronic shoulder pain using a mixture of local anesthetic and methylprednisolone.7 ESP block administered to the lumbar spine has been useful as an anesthetic strategy in hip and proximal femur surgery,8 in abdominal surgery,9 and in cesarean section.10
Is ESP block an alternative technique to the epidural and paravertebral approach? There are no comparative trials to date between this fascial block and the so-called standard techniques. The clinical evidence was initially limited to thoracic surgery and morphological analysis in cadavers. However, the future looks promising since a growing number of success cases are being documented with this new procedure which may be considered a basic, easy to learn block, with identification of structures, and low risk of complications because it is “distant” from the pleura, blood vessels, and the neuraxis.11–14
There have been several case reports on the use of ESP block in patients with oncological neuropathic pain, and case series of postthoracotomy pain syndrome—which is difficult to manage and responds poorly to analgesic agents—showing that ESP block provides palliative pain control and improves the patient's quality of life.15–19 A national, retrospective study described the use of ESP block in a population of 22 patients with chronic pain (38.1% of cancer etiology). There are quite advanced studies showing that the administration of local anesthetic agents and steroids results in lower VAS scores.
The authors have no funding to disclose.
The authors have no conflicts of interest to disclose.
1. Falk S, Bannister K, Dickenson AH. Cancer pain physiology. Br J Pain
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3. Forero M, Rajarathinam M, Adhikary S, et al. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: a case report. Case Rep
4. Orozco E, Serrano RE, Rueda-Rojas VP. Erector spinae plane (ESP) block for postoperative analgesia in total radical mastectomy: case report. Colombian Journal of Anesthesiology
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12. Adhikary SD, Pruett A, Forero M, et al. Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: a case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth
13. Luis-Navarro JC, Seda-Guzmán M, Luis-Moreno C, et al. The erector spinae plane block in 4 cases of video-assisted thoracic surgery. Rev Esp Anestesiol Reanim
14. Nandhakumar A, Nair A, Bharath VK, et al. Erector spinae plane block may aid weaning from mechanical ventilation in patients with multiple rib fractures: case report of two cases. Indian J Anaesth
15. Fusco P, Carlo DI, Scimia S, et al. Could the new ultrasound-guided erector spinae plane block be a valid alternative to paravertebral block in chronic chest pain syndromes? Minerva Anestesiol
16. Ahiskalioglu A, Alici HA, Ciftci B, et al. Continuous ultrasound guided erector spinae plane block for the management of chronic pain
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19. Forero M, Rajarathinam M, Adhikary S, et al. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: a case series. Scand J Pain