A novel modification to ultrasound guided lumbar erector spinae plane block: Tulgar approach

Tulgar, Serkan; Ünal, Ömer Kays; Thomas, David Terence; Özer, Zeliha

doi:10.1016/j.jclinane.2019.01.016

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…Only a few case reports have reported sensorial findings after lumbar ESPB. 8,17,23,25,28,30,[35][36][37][38][39][40][41][42][43][44][45][46][47] Spread of LA between T12 and S1 dermatomes were reported when 30-40 mL of LA was used, 28 with similar findings for the lower volume of 20 mL also reported. 30,38 Low volume injections have generally been utilized in back pain and spinal surgeries.…”

Section: Evaluation Of Sensorial Blocksupporting

confidence: 53%

“…This modification aims to block the lumbar plexus, which is close to the psoas major muscle. 17,18 In cases in which ultrasonography is unavailable, the landmark guided ESPB can be an alternative option. 19,20 In landmark guided ESPB, the procedure can be performed by targeting the transverse process 3 cm lateral to the spinous process for the thoracic and approximately 5-6 cm for the lumbar area.…”

Section: Dovepressmentioning

confidence: 99%

“…Lumbar ESPB was first described for hip surgery 8 and later for use in hip and femur surgery. 17,24,25,29,39,[64][65][66][67][68] Radiological evaluation and clinical results have shown that high volume lumbar ESPB results in similar analgesia as lumbar plexus block. 29,32 It has also been reported for the postoperative analgesia of knee surgery.…”

Section: Orthopedic Proceduresmentioning

confidence: 99%

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Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block

Tulgar¹,

Aydın²,

Ahıskalıoğlu³

et al. 2020

LRA

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Defined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in "Pubmed" and "Google Scholar" database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.

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Section: Evaluation Of Sensorial Blocksupporting

confidence: 53%

Section: Dovepressmentioning

confidence: 99%

Section: Orthopedic Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block

Tulgar¹,

Aydın²,

Ahıskalıoğlu³

et al. 2020

LRA

Self Cite

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“…Recently, a modification of the shamrock technique for lumbar ESPB performed under ultrasound guidance in the lateral position (Aksu-De Cassai technique) 25,26 was described as an easy-to-perform option in lumbar ESPB ( Figure 5). Another modification/approach for lumbar ESPB is the Tulgar approach, 27 in which local anesthetic is applied to both the posterior and anterior of the lumbar transverse process, which has a higher chance of guaranteeing block spread ( Figure 6).…”

Section: Approaches Sonography and Technical Featuresmentioning

confidence: 99%

“…A high-frequency linear probe is usually chosen for the thoracic area, although a curvilinear (2-5 MHz) probe may be required for obese patients. When one of the Aksu-Cassai, 25,26 Tulgar, 27 or Yorukoglu approaches is used, 22 a curvilinear (2-5 MHz) probe is suggested. The in-plane or out-of-plane technique should be used according to the physician's experience when inserting the needle for either thoracic or lumbar applications.…”

Section: Transducer Selection and Needle Orientationmentioning

confidence: 99%

Efficacy of bilateral erector spinae plane block in the management of pain: current insights

Tulgar¹,

Ahıskalıoğlu²,

Cassai³

et al. 2019

JPR

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117

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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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