The “new kid” on the fascial plane block: erector spinae block – a narrative review

Abstract

The erector spinae plane (ESP) block is a novel and versatile regional technique that involves the injection of local anaesthetic (LA) deep into the erector spinae muscle (ESM). LA is injected under ultrasound guidance at a site adjacent to the vertebral transverse processes and spreads along both the erector spinae fascial plane and the paravertebral fascial plane. The ESP block covers both visceral and somatic nociceptors and may be administered for the management of both acute and chronic pain for paediatric and adult patients. The procedure is simple to perform and the risk of complications is low with no major structures in close proximity to the injection site. ESP blocks are used for a wide range of applications and can be administered at the vertebral levels craniocaudally from cervical (C6) to lumbar (L4). Analgesic efficacy can be targeted by manipulating the LA agent used, the volume and concentration as well as the vertebral level(s) of insertion. LA spread may be titrated according to indication with a median of 3.4 ml injected volume offering analgesic coverage over one dermatome with distribution between two to five vertebral levels. The ESP block is an effective alternative when epidural blocks are contraindicated as well as for patients with coagulopathy. The ESP block is an innovative regional technique and should be considered in the analgesic management of polytrauma patients in South Africa. This narrative review aims to highlight the versatility and ease of application of the ESP block.