Bilevel-Bilateral Sacral Erector Spinae Plane Block for Chronic Pain Management: A Case Report and Short Literature Review

Abstract

Son yılların popüler rejyonel anestezi tekniklerinden biri olan erektor spina plan bloğu (ESPB), ilk olarak üst torasik nöropatik ağrı için kullanılmıştır. Daha sonra birçok farklı endikasyonda, farklı seviyelerden (alt torasik ve lomber) hem akut hem kronik ağrı tedavisinde, kullanılmıştır. Sınırlı deneyimimiz, bilevel biletaral uygulanan sakral ESPB'nun, perianal kronik intermittan (aralıklı) ağrının tedavisinde kolay ve etkili bir teknik olduğunu göstermektedir. Bununla birlikte, uygulama noktası, lokal anestezik volümü, duyusal blokaj alanı gibi araştırılması gereken birçok konu mevcuttur. Klinik araştırmaların yetersizliği nedeniyle, bu inceleme şu anda sakral ESPB blok etkinliğinin kanıtını ve rutin kullanımını destekleyememektedir. Sakral ESPB bloğunun etkinliği ve etki mekanizmasını açıklığa kavuşturmak için anatomik radyolojik ve klinik çalışmalara ihtiyaç vardır. Anahtar Kelimeler: Sakrum, erektor spina plan bloğu, kronik ağrı yönetimi, ultrasonografi, lokal anestezi Erector spinae plane block (ESPB), one of the popular regional anesthesia techniques in recent years, has first been used for upper thoracic neuropathic pain. Later, it has been used in many different indications for both acute and chronic pain treatment at different lower thoracic and lumbar levels. Our limited experience demonstrates that bilevel bilateral sacral ESPB is an easy and effective method in the treatment of perianal chronic intermittent pain. However, many issues, such as the application site, the volume of local anesthetics and the sensory blockade, still remain being investigated. Due to the lack of clinical research, our review is currently unable to support the evidence and routine use of sacral ESPB. We consider that anatomical radiological and clinical studies are needed to elucidate the efficacy and mechanism of action of sacral ESPB.

Unilateral Sacral Erector Spinae Plane Block for Thigh Amputation: Case Report

“…Literature suggests the potential for cranial spread of local anesthetics to reach the lumbar plexus, accounting for effective postoperative analgesia in perineal, anorectal, and urological surgeries. 7–9 The adequacy of this block for a hip fracture surgery where the patient remained awake has also been noted, indicating a promising application of a single-shot superficial block for lower limb procedures. 2 Nonetheless, our experience presents a caveat to this optimism, suggesting that the block may not reliably produce the depth of anesthesia necessary for such surgeries.…”

Ultrasound-Guided Sacral Erector Spinae Plane Block: A Feasible Option for Pain Management During Magnetic Resonance Imaging: A Case Report

“…Sacral ESPB has been successfully utilized as an anesthetic technique for anorectal surgeries, for postoperative analgesia in hypospadias surgery and pelvic-sacral fractures, as well as for chronic pain management. 5,6,13,14 However, the safety of fascial plane blocks in the NORA setting is not well described, and their use in this context is relatively rare. Considering that our patient underwent imaging rather than an interventional procedure, the volume and dose of local anesthetic were planned lower than reported in studies on the surgical analgesic use of sacral ESPB.…”

Sacral Erector Spinae Plane Block As the Main Anesthetic Method for Parasacral Reconstructive Surgeries: A Single-Center Retrospective Cohort Feasibility Study

“…Application of ESPB in the sacral region has been described by Tulgar et al [5] to provide sensory blockade in the parasacral region by blocking the posterior branches of the sacral nerves, and its use has been reported for many indications ranging from anorectal surgery to orthopedic surgery [6][7][8][9].…”