A Novel Use of the Erector Spinae Block in the Austere Environment

Fabich, Robert A.; Greene, Sharrod; Tighe, Currie A; Devasahayam, Rebekah J; Becker, Tyson E.

doi:10.1093/milmed/usz136

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…7,8 It has also been embraced by specialties outside of anesthesiology, including emergency medicine 9 and prehospital trauma care. 10,11 Controversy has accompanied the wide attention the ESP block has garnered. This has principally centred around the two questions: ''does it provide effective analgesia?''…”

Section: ' -Arthur Conan Doylementioning

confidence: 99%

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

279

168

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Section: ' -Arthur Conan Doylementioning

confidence: 99%

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Chin

El‐Boghdadly

2021

Can J Anesth/J Can Anesth

279

168

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“…One case report from a military retrieval service reports a multiinjection ESB in a prolonged transfer of a patient with chest trauma. 16 In contrast, in this case series, a larger injection volume was used to reduce the technique to a single injection.…”

Section: Discussionmentioning

confidence: 98%

Erector Spinae Block for Chest Trauma in Aeromedical Prehospital and Retrieval Medicine

Ibbotson

Greenberg

Brendt

2020

Prehosp. Disaster med.

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Pain management for patients with chest trauma in aeromedical prehospital and retrieval medicine is important in order to maintain respiratory function. However, it can be challenging to achieve with opioids alone due to side effects including sedation, respiratory depression, and nausea.Reported are two trauma patients with uncontrolled pain despite multiple doses of opioids managed with a single-injection erector spinae plane block (ESB).The sono-anatomy and performance of the block, indications, and possible complications associated with the ESB are described.An ultrasound-guided ESB is useful for multimodal pain therapy following chest trauma in aeromedical retrieval medicine.

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“…Its simplicity has contributed to its use by non-anaesthetists and in out-oftheatre settings, including the emergency department [84] and pre-hospital retrieval [85,86]. Apart from case reports [84][85][86][87] and small series that demonstrate the effectiveness of both single-injection and continuous ESP blocks for rib fracture analgesia [88,89], the current literature also includes two retrospective cohort studies. The first examined 79 patients who received an ESP block for rib fracture analgesia and found a meaningful improvement in incentive spirometry and pain scores in the first 3 h following block performance [90].…”

Section: Posterior Chest Wallmentioning

confidence: 99%

“…There has been much interest in the ESP block as an alternative to thoracic paravertebral blockade and thoracic epidural anaesthesia in chest trauma. Its simplicity has contributed to its use by non-anaesthetists and in out-oftheatre settings, including the emergency department [83] and pre-hospital retrieval [84,85]. Apart from case reports [83][84][85][86] and small series that demonstrate the effectiveness of both single-injection and continuous ESP blocks for rib fracture analgesia [87,88], the current literature also includes two retrospective cohort studies.…”

Section: Posterior Chest Wallmentioning

confidence: 99%

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

2021

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Summary Ultrasound‐guided fascial plane blocks of the chest wall are increasingly popular alternatives to established techniques such as thoracic epidural or paravertebral blockade, as they are simple to perform and have an appealing safety profile. Many different techniques have been described, which can be broadly categorised into anteromedial, anterolateral and posterior chest wall blocks. Understanding the relevant clinical anatomy is critical not only for block performance, but also to match block techniques appropriately with surgical procedures. The sensory innervation of tissues deep to the skin (e.g. muscles, ligaments and bone) can be overlooked, but is often a significant source of pain. The primary mechanism of action for these blocks is a conduction blockade of sensory afferents travelling in the targeted fascial planes, as well as of peripheral nociceptors in the surrounding tissues. A systemic action of absorbed local anaesthetic is plausible but unlikely to be a major contributor. The current evidence for their clinical applications indicates that certain chest wall techniques provide significant benefit in breast and thoracic surgery, similar to that provided by thoracic paravertebral blockade. Their role in trauma and cardiac surgery is evolving and holds great potential. Further avenues of research into these versatile techniques include: optimal local anaesthetic dosing strategies; high‐quality randomised controlled trials focusing on patient‐centred outcomes beyond acute pain; and comparative studies to determine which of the myriad blocks currently on offer should be core competencies in anaesthetic practice.

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A Novel Use of the Erector Spinae Block in the Austere Environment

Cited by 4 publications

References 7 publications

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Mechanisms of action of the erector spinae plane (ESP) block: a narrative review

Erector Spinae Block for Chest Trauma in Aeromedical Prehospital and Retrieval Medicine

Ultrasound‐guided fascial plane blocks of the chest wall: a state‐of‐the‐art review

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