Transverse Approach to the Erector Spinae Block

Hruschka, James A.; Arndt, Christopher

doi:10.1097/aap.0000000000000836

Cited by 15 publications

(5 citation statements)

References 1 publication

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“…Thereafter, the transverse-approach technique was described as placing the ultrasound probe on the transverse plane and inserting the needle from lateral to medial direction using the in-plane technique ( Figure 1, C and D). [19][20][21] Most recently, Yorukoglu et al 22 described their technique in which bilateral ESPB was performed using one needle insertion over the spinous process that was advanced medially to laterally on both sides, described by the authors as a safe and easy technique for performing bilateral ESPB (Figure 4).…”

Section: Approaches Sonography and Technical Featuresmentioning

confidence: 99%

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Tulgar¹,

Ahıskalıoğlu²,

Cassai³

et al. 2019

JPR

119

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Erector spinae plane block (ESPB) is a newly described interfascial plane block, and the number of articles on the bilateral application of ESPB is increasing in the literature. In this paper, in addition to analyzing bilateral ESPB cases and studies published so far, we aimed to review the relevant anatomy, describe the mechanism of spread of the injectant, demonstrate varying approaches to ESPB, and summarize case reports and clinical trials, as well as provide current insight on this emerging and popular block. Randomized controlled studies, comparative studies of ESPB versus other methods, and pharmacokinetic studies of bilateral applications must be the next step in clearly understanding bilateral ESPB.

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Section: Approaches Sonography and Technical Featuresmentioning

confidence: 99%

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Tulgar¹,

Ahıskalıoğlu²,

Cassai³

et al. 2019

JPR

119

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“…An ESPB is performed under ultrasound guidance by injecting local anesthetic deep to the erector spinae muscle, with the goal of hydro‐dissecting the tissue fascial plane at the level of the transverse processes. The technique has been described using both parasagittal and transverse approaches . Numerous cadaveric and contrast‐assisted imaging studies have demonstrated spread of local anesthetic cranial‐caudally up to nine dermatomes and anterior‐posteriorly into the paravertebral space reaching the ventral and dorsal spinal rami .…”

Section: Introductionmentioning

confidence: 99%

Early experience with erector spinae plane blocks in children

Holland

Bösenberg

2020

Pediatric Anesthesia

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Background An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is limited. Aim Our objective was to determine the efficacy of the erector spinae plane block in children by measuring the heart rate response to incision. Secondary objectives included feasibility, safety, opioid consumption, and pain scores. Furthermore, we reviewed this block in children published since 2016. Study design Case Series; Level of evidence, IV. Methods With Institutional Review Board approval, a retrospective chart review was conducted on all patients who received erector spinae plane block for surgery between October 2017 and May 2019 at a single institution. Blocks were performed under anesthesia, using ultrasound guidance prior to surgical incision. Block details and hemodynamic and analgesic data were collected. In addition, a PubMed literature review was conducted to identify all erector spinae plane block related publications in patients ≤18 years of age. Results About 164 patients, 2 days‐19.4 years, weighing 2.3‐94.7 kg, received erector spinae plane blocks. For more than 79% of single injection blocks, placement time was ≤10 minutes. Using a heart rate increase of <10% at skin incision as criterion, 70.1% of patients had a successful block. Only 20% required long‐acting opioids intraoperatively. In a subset of infants who underwent gastrostomy surgery using a dose of 0.5 mL/kg, a local anesthetic spread of at least five dermatomes (0.1 mL/kg/dermatome) was achieved. Per the literature review, 33 publications described erector spinae plane block in 128 children. No complications were reported. Conclusion Erector spinae plane blocks are relatively easy to perform in children with no complications reported to date. The efficacy of the block for a broad spectrum of surgeries, involving incisions from T1 to L4, is encouraging.

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“…10,11 The local anesthetic is injected deep to the erector spinae muscle. 11,12 This allow the spread of local anesthetic cranio-caudally up to nine dermatomes and antero-posteriorly into the paravertebral space reaching the ventral and dorsal spinal rami. 13,14,15 To date, no studies have compared postoperative pain control in children receiving an ESPB with those receiving a QLB2 for abdominal laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

Taman¹,

Saber²,

Farid³

et al. 2022

Anaesth. pain intensive care

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Background: Postoperative pain management in children can be effectively controlled using regional analgesic techniques. In general, neuraxial blocks pose a higher risk of adverse effects and complications in comparison to peripheral nerve blocks. Recently, both quadratus lumborum block (QLB) and erector spinae plan block (ESPB) have been used to achieve adequate postoperative analgesia in children. We compared the efficacy of both in postoperative pain management after laparoscopic abdominal surgery. Methodology: Eight five patients with laparoscopic abdominal surgery received either bilateral QLB or ESPB at the level of T8 transverse process with 0.5 ml/kg of 0.25% bupivacaine to achieve adequate postoperative analgesia. FLACC score was used to assess pain score after surgery and the need for rescue opioid analgesia. Results: The average dose of fentanyl was lower and the time to the first dose of rescue analgesic was longer in QLB group when compared to ESPB group. In addition, FLACC scores were significantly lower in QLB group in comparison to ESPB group at the 6th, 8th, 12th and 20th h after surgery. Conclusion: Quadratus lumborum block can provide longer and more effective postoperative analgesia in pediatric patients following laparoscopic abdominal surgery in comparison to erector spinae plan block. Citation: Taman HI, Saber HIES, Farid AM, Elawady MM. Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study. Anaesth. pain intensive care 2022;26(5):602-607; DOI: 10.35975/apic.v26i5.2017

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Transverse Approach to the Erector Spinae Block

Cited by 15 publications

References 1 publication

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

<p>Efficacy of bilateral erector spinae plane block in the management of pain: current insights</p>

Early experience with erector spinae plane blocks in children

Bilateral erector spinae plane block vs quadratus lumborum block for pediatric postoperative pain management after laparoscopic abdominal surgery: a double blinded randomized study

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