Erector spinae plane block for pain relief in rib fractures

Erector Spinae Plane Block Versus Retrolaminar Block

“…These have invariably demonstrated that injectate spreads beyond the paravertebral space into the epidural and intercostal spaces in a significant proportion of cases. Our findings lend further support to the presumption that retrolaminar and ESP blocks are viable alternatives to thoracic paravertebral blockade 8,9,13 ; however, comparative clinical studies are clearly required for confirmation.…”

“…This was seen across 2 to 5 vertebral levels centered around the level of injection and provides a basis for the somatic and visceral analgesia that has been reported. [1][2][3][6][7][8][9][10][11][12][13] It also confirms the existence of anatomical pathways for anterior spread of local anesthetic. While the exact pathways have yet to be defined, they probably include the perforations in the intertransverse connective tissues through which the dorsal rami of spinal nerves and accompanying vessels emerge.…”

“…More importantly, the ESP block produced spread into up to 9 intercostal spaces from a single point of injection. This enhanced coverage allows for effective somatic analgesia in surgeries where incisions are widely spaced (such as thoracotomy with chest tube insertion 9 ), multiple rib fractures, 13 or where the surgical field or wound dressings prevent injection at a level congruent with the surgical site. 11 Limitations of this study include the small sample size and the fact that it was performed in cadavers, albeit fresh ones.…”

Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient

“…6,8,9 We have been able to achieve adequate spread and analgesia with a volume of 0.2 to 0.3 mL/kg of LA in other pediatric patients undergoing thoracic surgery, and our results are in keeping with the analgesic efficacy of ESP block reported for thoracic spine surgery, thoracotomy, and rib fracture in the adult population. [10][11][12] However, our case report has several limitations. First, because the patient went home at 4 hours after surgery, we only can report the time of first analgesic administration, not the full time course of pain scores.…”

Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols

“…Under ultrasound guidance, about 20 mL of local anesthetic are injected 3 cm beside the interspinous line at T5 level deep to the trapezius, rhomboid and erector spinae muscles. ESPB has been proposed for thoracic neuropathic pain, rib fractures and as rescue in thoracotomy after epidural failure (72)(73)(74). Currently, the lack of experience with this technique does not allow to define its role in the treatment of pain after VATS and hence its use is not yet recommended.…”