Now, the erector spinae plane block (ESPB) is widely used in various thoracolumbar surgeries. It has unique advantages: simple and convenient operation, low safety risks, and reduced opioid use. The ESPB is used in thoracic surgery, abdominal surgery, and spinal surgery. There are also relevant research reports on postoperative analgesia during general anesthesia surgery. This article searches the PubMed and Web of Science databases to find and screen relevant studies on ESPB since 2019 and retrospectively summarizes the current indications of ESPB. The methodological quality of the included studies was assessed using the Cochrane bias risk tool. The results showed that the current research on ESPB generally provides low-level clinical evidence. The complex anatomy of the erector spinae muscles is both responsible for its unique advantages and restricts its development. Few anatomical studies have clearly and completely demonstrated the diffusion relationship of local anesthetics among the anatomical structures of the erector spinal muscles. The uncontrollability of the diffusion plane prevents ESPB from being applied on a wider scale with a high level of evidence. To further clarify the scope of application of ESPB and achieve the best analgesic effect, in the future, we should focus on the unique anatomical course and distribution of the erector spinal muscles and their fascia and nerves. It is necessary to combine anatomical, imaging, and histological methods to obtain high-quality evidence to guide clinical application. 

The Analgesic Mechanism and Recent Clinical Application of Erector Spinae Plane Block: A Narrative Review

Introduction: The erector spinae plane (ESP) block is a regional anesthetic technique that involves injecting a local anesthetic below the erector spinae muscle in an interfascial plane. Case Presentation: We report a case of a 66-year-old man with cervicothoracic junction pain caused by an advanced Pancoast tumor. The administration of ESP block at the T2-T3 level led to pain relief of more than 50% in this patient after two sessions. Conclusions: Therefore, the application of this method of regional analgesia is both convenient and safe and reduces opioid consumption. Further studies are needed to evaluate the safety and effectiveness of continuous blocks in outpatient settings.

/pdf/erector-spinae-plane-block-for-the-treatment-of-intractable-2q9ebxrv.pdf

Erector Spinae Plane Block for the Treatment of Intractable Pain in a Patient with Pancoast Tumor: A Case Report

Analgesia for open liver resection surgery.

Pain research: beyond the planes.

Purpose Percutaneous transhepatic biliary drainage (PTBD) is associated with significant procedural pain, typically managed with opioid-based sedation, which carries risks such as respiratory depression, nausea, and hemodynamic instability. The erector spinae plane block (ESPB) has emerged as an opioid-sparing alternative for perioperative pain management. This study aimed to evaluate the analgesic efficacy of ESPB compared to procedural analgesia with fentanyl (PAF) in PTBD patients. Methods Patients who underwent PTBD with ESPB or PAF were assessed using the Numeric Rating Scale (NRS) at five time points: pre-procedure, intra-procedure, and 1, 6, and 12 h post-procedure. Opioid consumption and procedure-related complications were also recorded. Results 101 patients who underwent PTBD with either pre-procedural ESPB (n = 41) or PAF (n = 60) were included. The ESPB group demonstrated significantly lower median pain scores at 1 h (3 vs. 6, p < 0.001), 6 h (2 vs. 4, p < 0.001), and 12 h (1 vs. 2, p < 0.001) post-procedure compared to the PAF group. Although intra-procedural pain scores were comparable between the two groups, patients in the ESPB group experienced a more rapid decline in post-procedural pain, returning to near-baseline levels at 1 h, whereas pain in the PAF group remained elevated (p < 0.001). No patients in the ESPB group required additional opioid analgesia post-procedure, whereas tramadol was administered in the PAF group as needed for breakthrough pain (NRS ≥ 6). Conclusion ESPB provides effective analgesia for PTBD, minimizing opioid use while enhancing patient comfort and procedural success. Graphical Abstract

Erector Spinae Plane Block for Percutaneous Transhepatic Biliary Drainage: A Comparative Analysis

The aim of this study was to compare the analgesic efficacy of erector spinae plane block (ESPB) in relation to subcostal transversus abdominis plane block (TAPB) in patients undergoing open liver resection surgery. In this randomized controlled trial, we included adult patients undergoing open liver resection surgery. After induction of general anaesthesia, the included patients were randomized to receive either ESPB (n = 30) or subcostal TAPB (n = 30). Postoperative pain was assessed using the numeric rating scale (NRS) at rest and during cough. Intravenous morphine boluses were used for management of breakthrough pain intra- and postoperatively. The study’s primary outcome was morphine consumption during the first 24 h postoperatively. Secondary outcomes included intraoperative morphine consumption, time to first postoperative morphine requirement, incidence of complications, and patient satisfaction. Sixty patients were included and were available for the final analysis in this study. The intra-and postoperative morphine requirements were less in the ESPB group than the subcostal TAPB group (median [quartiles] morphine dose: 0 [0-0] vs 2 [0-5] mg, p = 0.007 and 20 [15–20] vs 25 [20-30] mg, p = 0.006, respectively). The time to first morphine requirement was longer in the ESPB group (median [quartiles]: 6.5 [5.5-6.5] hours) than the subcostal TAPB group (median [quartiles]: 4.3 [1.0-6.5] hours), P = 0.013. Patients in the ESPB group had lower incidence of sedation and higher level of satisfaction than the subcostal TAPB group. In patients undergoing open liver resection surgery, ESPB provided superior analgesic properties than subcostal TAPB. Clinical trial registration: NCT05253079, Principal investigator: Maha Mostafa, Date of registration: February 23, 2022. URL: https://clinicaltrials.gov/ct2/show/NCT05253079 

Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: a randomized controlled trial.

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Erector spinae plane block versus subcostal transversus abdominis plane block in patients undergoing open liver resection surgery: a randomized controlled trial.