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Expanding Role of the Erector Spinae Plane Block for Postoperative and Chronic Pain Management

  • Hot Topics in Pain and Headache (N Rosen, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The erector spinae plane block (ESPB), first described in 2016, offers the promise of becoming a safe, less invasive, and technically less demanding alternative to conventional thoracic regional anesthetic techniques including thoracic epidurals and traditional paravertebral blocks. Clinical and cadaveric studies suggest that ESPB acts on the ventral rami of spinal nerves in the paravertebral space via penetration of the intertransverse connection tissues and moreover achieves visceral analgesia via the rami communicantes and sympathetic chain.

Recent Findings

The block has garnered considerable appeal related to an inherently lower risk of neurovascular and pleural injury, low risk of local anesthetic systemic toxicity, and relative technical simplicity in comparison with epidural or paravertebral blockade. It has been utilized in the treatment of acute perioperative pain in a variety of clinical applications including breast, thoracic, and abdominal surgeries and trauma and may even offer some benefit in spine surgery.

Summary

Given the combination of its efficacy and decreased associated risk when performed for perioperative pain, use of ESPB should be further explored for the management of chronic pain. Current literature at this time is limited to case studies and series performed by select groups. Though it is important to consider ESPB for chronic pain, further studies are needed to evaluate the efficacy and safety of the ESPB in the management of both acute and chronic pain.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. El-Boghdadly K, Pawa A. The erector spinae plane block: plane and simple. Anaesthesia. 2017;72:434–8.

    Article  CAS  Google Scholar 

  2. Forero 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.

    Article  CAS  Google Scholar 

  3. • Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 2018;43:567–71 A cadaveric investigation describing the mechanism of the ESPB.

    Article  Google Scholar 

  4. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block. Reg Anesth Pain Med. 2018;43:756–62.

    PubMed  Google Scholar 

  5. • Schwartzmann A, Peng P, Maciel MA, Forero M. Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Can J Anesth Can d’anesthésie. Springer US; 2018;65:1165–6. A radiographic investigation describing the mechanism of the ESPB.

    Article  Google Scholar 

  6. • Fusco P, Dicarlo S, Scimia P, Luciani A, Petrucci E, Marinangeli F. Could the new ultrasound-guided erector spinae plane block be a valid alternative to paravertebral block in chronic chest pain syndromes? Minerva Anestesiol. 2017;83:1112–3 A study to assess the ESPB as an alternative to paravertebral blocks in chronic pain.

    PubMed  Google Scholar 

  7. Hamilton DL. Pneumothorax following erector spinae plane block. J Clin Anesth. Elsevier; 2018;52:17.

    Article  Google Scholar 

  8. Bonvicini D, Tagliapietra L, Giacomazzi A, Pizzirani E. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth.. Elsevier Inc; 2018;44:3–4.

    Article  Google Scholar 

  9. Ueshima H, Otake H. Limitations of the erector spinae plane (ESP) block for radical mastectomy. J Clin Anesth. Elsevier; 2018;51:97.

    Article  Google Scholar 

  10. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth. The Author(s); 2017;118:474–5.

    Article  CAS  Google Scholar 

  11. Takahashi H, Suzuki T. Erector spinae plane block for low back pain in failed back surgery syndrome : a case report. JA Clin Rep. 2018:6–9.

  12. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery a report of 3 cases. Reg Anesth Pain Med. 2017;42:372–6.

    Article  Google Scholar 

  13. Kim E, Kwon W, Oh S, Bang S. The erector spinae plane block for postoperative analgesia after percutaneous nephrolithotomy. Chin Med J. 2018;131:1877–8.

    Article  Google Scholar 

  14. Forero M, Rajarathinam M, Adhikary S, Chin KJ. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: a case series. Scand J Pain. Elsevier B.V.; 2017;17:325–9.

    Article  Google Scholar 

  15. Ahiskalioglu A, Alici HA, Ciftci B, Celik M, Karaca O. Continuous ultrasound guided erector spinae plane block for the management of chronic pain. Anaesth Crit Care Pain Med. Société française d’anesthésie et de réanimation (Sfar); 2018;2017–8.

  16. Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anesth Can d’anesthésie. Springer US; 2017;65:288–93.

    Article  Google Scholar 

  17. Ueshima H, Otake H. Erector spinae plane block for pain management of wide post-herpetic neuralgia. J Clin Anesth. Elsevier; 2018;51:37.

    Article  Google Scholar 

  18. Melvin J, Schrot R, Chu G, Chin K. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 2018;65:1057–65.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Ivan Urits & Vwaire Orhurhu

  2. Georgetown University School of Medicine, Washington, DC, USA

    Karina Charipova & Kyle Gress

  3. US Anesthesia Partners – Colorado, Denver, CO, USA

    Patrick Laughlin

  4. Hospital for Special Surgery, New York City, NY, USA

    Patrick Laughlin

  5. Creighton University School of Medicine, Omaha, NE, USA

    Patrick Laughlin

  6. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Alan D. Kaye

  7. Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Omar Viswanath

  8. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA

    Omar Viswanath

  9. Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA

    Omar Viswanath

Authors
  1. Ivan Urits
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  2. Karina Charipova
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  3. Kyle Gress
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  4. Patrick Laughlin
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  5. Vwaire Orhurhu
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  6. Alan D. Kaye
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  7. Omar Viswanath
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Corresponding author

Correspondence to Ivan Urits.

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Conflict of Interest

Ivan Urits, Kyle Gress, Karina Charipova, Patrick Laughlin, Vwaire Orhurhu, and Omar Viswanath declare no conflict of interest. Alan D. Kaye discloses that he is on the Speakers Bureau for Depomed, Inc. and Merck.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Urits, I., Charipova, K., Gress, K. et al. Expanding Role of the Erector Spinae Plane Block for Postoperative and Chronic Pain Management. Curr Pain Headache Rep 23, 71 (2019). https://doi.org/10.1007/s11916-019-0812-y

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  • DOI: https://doi.org/10.1007/s11916-019-0812-y

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