Reply to letter to editor regarding ‘Variable anterior spread of local anesthetic after erector spinae plane block (ESPB): time to turn the spotlight on the ‘retro-SCTL space’

Sørenstua, Marie; Zantalis, Nikolaos; Ræder, Johan; Vamnes, Jan Sverre; Leonardsen, Ann‐Chatrin Linqvist

doi:10.1136/rapm-2023-104392

Reg Anesth Pain Med

2023

DOI: 10.1136/rapm-2023-104392

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Reply to letter to editor regarding ‘Variable anterior spread of local anesthetic after erector spinae plane block (ESPB): time to turn the spotlight on the ‘retro-SCTL space’

Marie Sørenstua

Nikolaos Zantalis

Johan Ræder

et al.

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2024

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Differential nerve blockade to explain anterior thoracic analgesia without sensory blockade after an erector spinae plane block may be wishful thinking

Sivakumar,

Luckanachanthachote,

Karmakar

2024

Reg Anesth Pain Med

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Ultrasound-guided erector spinae plane block (ESPB) is currently used as a component of multimodal analgesic regimen in a multitude of indications but the mechanism by which it produces anterior thoracic analgesia remains a subject of controversy. This is primarily the result of ESPB’s failure to consistently produce cutaneous sensory blockade (to pinprick and cold sensation) over the anterior hemithorax. Nevertheless, ESPB appears to provide ‘clinically meaningful analgesia’ in various clinical settings. Lately, it has been proposed that the discrepancy between clinical analgesia and cutaneous sensory blockade could be the result of differential nerve blockade at the level of the dorsal root ganglion. In particular, it is claimed that at a low concentration of local anesthetic, the C nerve fibers would be preferentially blocked than the Aδ nerve fibers. However, the proposal that isolated C fiber mediated analgesia with preserved Aδ fiber mediated cold and pinprick sensation after an ESPB is unlikely, has never been demonstrated and, thus, without sufficient evidence, cannot be attributed to the presumed analgesic effects of an ESPB.

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Differential nerve blockade to explain anterior thoracic analgesia without sensory blockade after an erector spinae plane block may be wishful thinking

Sivakumar,

Luckanachanthachote,

Karmakar

2024

Reg Anesth Pain Med

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Reply to letter to editor regarding ‘Variable anterior spread of local anesthetic after erector spinae plane block (ESPB): time to turn the spotlight on the ‘retro-SCTL space’

Cited by 1 publication

References 6 publications

Differential nerve blockade to explain anterior thoracic analgesia without sensory blockade after an erector spinae plane block may be wishful thinking

Differential nerve blockade to explain anterior thoracic analgesia without sensory blockade after an erector spinae plane block may be wishful thinking

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