Erector Spinae Block

A Summary of Erector Spinae Block

The erector spinae block provides somatic and visceral pain relief to the anterolateral and posterior thoracoabdominal wall. This technique was originally used in managing chronic neuropathic pain, but it has also shown to be beneficial for variety of surgical procedures involving the breast, thoracic cage, spine, and abdomen.

Overview of the Erector Spinae Block

The erector spinae muscle is comprised of three muscles: the iliocostalis, longissimus, and spinalis muscles. These structures run bilaterally from the skull to the pelvis and from the spinous to the transverse processes. As core muscles, their primary function is to provide stability to the spine.

The erector spinae block (ESPB) is a novel technique that is performed with ultrasound-guidance as a single injection block or as a continuous infusion with an indwelling catheter. Local anesthetic deposited within the interfascial plane between the erector spinae muscle and the transverse process spreads in a cranio-caudal fashion over several vertebral segments.  From this plane, local anesthetic may spread anteriorly into the paravertebral space where it can target the dorsal rami, ventral rami, rami communicantes, and sympathetic ganglia.

Risks and Side Effects

With any procedure where regional anesthesia is administered, there can be inherent risks. Potential complications of an ESPB include:

  • Bleeding
  • Infection
  • Local anesthetic systemic toxicity
  • Pneumothorax
  • Block failure

How to Perform an Erector Spinae Block

The erector spinae block technique can be administered in sitting, lateral, or prone positions.

To perform the block, follow these steps:

  1. Position the ultrasound transducer in a longitudinal plane 5cm lateral to the spinous process over the ribs at the corresponding thoracic level.
  1. Slide the transducer in a medial direction until the costotransverse junction is reached.
  1. Insert block needle and advance in-plane using a cephalad to caudad direction toward the transverse process until the needle contacts the bone.
  1. Following negative aspiration, inject 1-2ml of normal saline to verify needle tip placement.
  1. Carefully administer 3-5ml incremental doses of local anesthetic up to a total volume of 20-30ml per side.

Get Complete Instructions in the Block Buddy Pro App

If you want to dive in with further detail, Block Buddy Pro is the ultimate resource for anesthesia providers. On Block Buddy, you can access the full lesson plan and corresponding videos, which includes:

  • Easy-to-follow instructions
  • Narrated video with step-by-step instructions
  • Detailed images, illustrations, and anatomical breakdowns
  • Equipment list and CPT codes

Block Buddy is a medical resource in your pocket. Equipped with this powerful tool, you can watch videos, view ultrasound images, and read detailed descriptions of more than 33 different blocks.

 

SIGN UP TODAY!