Saudi Journal of Anaesthesia

EDITORIAL
Year
: 2019  |  Volume : 13  |  Issue : 1  |  Page : 1--2

Erector spinae plane block: New block with great expectations


Can Aksu, Yavuz Gürkan 
 Department of Anaesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli, Turkey

Correspondence Address:
Dr. Can Aksu
Department of Anaesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli
Turkey




How to cite this article:
Aksu C, Gürkan Y. Erector spinae plane block: New block with great expectations.Saudi J Anaesth 2019;13:1-2


How to cite this URL:
Aksu C, Gürkan Y. Erector spinae plane block: New block with great expectations. Saudi J Anaesth [serial online] 2019 [cited 2019 Apr 21 ];13:1-2
Available from: http://www.saudija.org/text.asp?2019/13/1/1/248855


Full Text



The practice of regional anaesthesia is constantly evolving and shifting to minimally invasive techniques that provide maximum safety. Erector spinae plane (ESP) block was first described by Forero et al.[1] for thoracic analgesia but since then it has been used for many different indications where paravertebral block (PVB) and epidural anaesthesia are currently the main regional techniques.[2],[3] There are a few randomized controlled trials but there are many case reports/editorials about its use.[4],[5] However there is still significant work to be done both for finding out the real indications and limits of this promising new method.

In this issue of the Saudi Journal of Anaesthesia, with the case report of De Cassai et al,[6] ESP has been highlighted as a rescue analgesia method. As stated by authors, the exact mechanism of action is not that clear. Forero et al.[1] reported that the local anaesthetic spread involved both the ventral and dorsal rami of spinal nerves while Ueshima and Hiroshi[7] suggested a paravertebral spread. However, very recently published cadaveric study of Ivanusic et al.[8] showed no spread to both paravertebral space and ventral rami. On the other hand, a recently published magnetic resonance imaging and anatomical study has reported epidural and intercostal spread.[9]

Many controversial results as above can be found in the literature. One way or another ESP block has found to be effective in a wide range of indications both in paediatric and adult patients. Especially in paediatrics, quality of analgesia provided by ESP block has shown to be highly satisfying. While Tulgar et al.[3] reported rescue analgesic usage in adult patients after laparoscopic cholecystectomy; Aksu and Gürkan[4] showed that there was no need for any additional analgesic in paediatric patients. Other reports on the use of ESP block in paediatric patients also support these findings.[5]

Although it is much more common practice to perform nerve blocks for upper and lower extremity surgeries; today anaesthesiologists have a large armamentarium of different interfascial plane blocks to cover abdominal and thoracic surgeries. As part of multimodal analgesia technique, we think that almost every patient undergoing surgery can benefit from one or other block. Ultrasound guidance makes regional anaesthesia technically easier and safer. Opioid sparing effects of regional anaesthesia has been known and recommended by current enhanced recovery after surgery (ERAS) protocols.

ESP, in these case reports have been used as a rescue block after surgeries yet we strongly recommend that regional anaesthesia techniques should be performed preoperatively whenever possible. Due to a well-known fact that unrelieved acute pain could lead to chronic pain, regional anaesthesia techniques should be used as a part of the multimodal analgesia methods.

References

1Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621-7.
2Gürkan Y, Aksu C, Kuş A, Yörükoğlu UH, Kılıç CT. Ultrasound guided erector spinae plane block reduces postoperative opioid consumption following breast surgery: A randomized controlled study. J Clin Anesth 2018;50:65-8. doi: 10.1016/j.jclinane.2018.06.033. [Epub ahead of print].
3Tulgar S, Kapakli MS, Şentürk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth 2018;49:101-6. doi: 10.1016/j.jclinane.2018.06.019. [Epub ahead of print].
4Aksu C, Gürkan Y. Ultrasound-guided bilateral erector spinae block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients. Anaesth Crit Care Pain Med 2018 doi: 10.1016/j.accpm.2018.03.008. [Epub ahead of print].
5Aksu C, Gürkan Y. Opioid sparing effect of erector spinae plane block for pediatric bilateral inguinal hernia surgeries. J Clin Anesth 2018;50:62-3. doi: 10.1016/j.jclinane.2018.06.048. [Epub ahead of print].
6De Cassai A, Cin SD, Zarantonello F, Ban I. Erector spinae plane block as a rescue therapy for uncontrolled pain after laparotomic surgery: A report of two cases. Saudi J Anaesth 2019;13:66-8.
7Ueshima H, Hiroshi O. Spread of local anesthetic solution in the erector spinae plane block. J Clin Anesth 2018;45:23.
8Ivanusic JJ, Konishi YY, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med 2018;43. [Epub ahead of print] https://doi.org/10.1097/AAP.0000000000000789.
9Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: A magnetic resonance imaging and anatomical study. Reg Anesth Pain Med 2018. E-pub ahead of print. DOI: 10.1097/AAP.0000000000000798.