July 20, 2019
Erector Spinae Plane Block
A novel inter-fascial plane block first described in 2016. This technique has been used for analgesia for the following procedures:
- Video-assisted thoracoscopic surgery (VATS)
- Pulmonary lobectomy
- Thoracic rib and sternal fractures
- Mastectomy
- Axillary sentinel lymph node biopsy
- Abdominal surgery
- Hip surgery
- Thoracic neuropathic pain relief
Unique Contraindications:
- Localized active infectious process at injection site
- Extensive tissue depth between skin and transverse process limiting visualization of transverse process
Unique Complications:
- Pneumothorax
- Lower extremity motor weakness if performed at lower thoracic level
Technique:
- Transverse probe at midline of the spine and identify spinous process, lamina, transverse process and rib
- Slide probe laterally and center view over transverse process
- Rotate probe 90 degrees to parasagittal view of transverse process
- Insert needle from cranial to caudal direction and contact transverse process
- Inject local anesthetic aiming for pooling above transverse process and lifting of erector spinae muscle. For this video, 30 ml of Ropivacaine 0.5% was used.
Tips:
- Other postural positions (i.e. prone or lateral) may facilitate placement
- Although the T5 transverse process had been the traditional plane of insertion, the block can be performed at any level
- Rostral spread 2-3 levels and approximately 5 levels caudally
- Ultrasound identification/differentiation of the target transverse process and its transition to its adjacent rib can ensure injection at the correct site
- Transverse process appears as blunt and flat while the rib is seen as round on ultrasound with pleura clearly seen in close proximity
- Constant visualization of the needle along its entire length until its contact to the transverse process may decrease the likelihood of a pneumothorax
- Consider use of weight-appropriate dose of local anesthetic to decrease the likelihood of LAST
Block Anesthesiologist: Gloria Shih Cheng, M.D.
Synopsis: Jose Enrique Lagueras Garcia, M.D.
Production: Sandy Thammasithiboon, M.D. / ST Film
References: