Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane

Abstract

Post-operative pain after minimally invasive video-assisted thoracoscopic surgery (VATS) in adults is commonly managed with oral and parenteral opioids and invasive regional techniques such as thoracic epidural blockade. Emerging research has shown that the novel erector spinae plane (ESP) block, can be employed as a simple and safe alternative analgesic technique for acute post-surgical, post-traumatic and chronic neuropathic thoracic pain in adults. We illustrate this by presenting a paediatric case of VATS, in which an ESP block provided better analgesia, due to greater dermatomal coverage, as well as reduced side-effects when compared with a thoracic epidural that had previously been employed on the same patient for a similar procedure on the opposite side.

Defining the Indications and Levels of Erector Spinae Plane Block in Pediatric Patients: A Retrospective Study of Our Current Experience

“…Indications for ESPB for postoperative analgesia in pediatric surgeries to date include thoracotomy [8][9], video-assisted thoracoscopic surgery [10], pectus excavatum/carinatum [11], vascular ring repair [12], sternotomy [13], major abdominal surgery [14], laparoscopic cholecystectomy [15][16], nephrectomy [17], pyeloplasty [18], inguinal hernia repair [7,[19][20][21], orchiopexy [7], hydrocelectomy [7], varicocelectomy [22] and hip surgery [23]. There has also been one report of its use in pain management in pediatric palliative care [24].…”

“…There have been a few randomized prospective studies of ESPB in terms of its clinical effectiveness, but all, with one exception, have involved adults [5][6][7]. Pediatric case reports are also limited compared to adults [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We have been applying ESPB almost since it was first described.…”

The Pattern of Contrast Dye through the Thoracic Paravertebral Catheter Does Not Predict Analgesic Efficacy after Breast Cancer Surgery: A Prospective Cohort Study

“…The posterior spread may be the spread into the erector spinae plane. In our present report, there is the possibility that the cloud-like spread worked as the erector spinae block for pain management [20]. Finally, we calculated the sample size that is necessary to reach that power (α = 0.05, β = 0.8).…”

By Ultrasonic-Guided Erector Spinae Block, Thoracic Paravertebral Block versus Serratus Anterior Plane Block by Articaine with Adrenaline during Breast Surgery with General Anesthesia: A Comparative Study of Analgesic Effect Post-Operatively: Double Blind Randomized, Controlled Trial

“…The drug spreads in superio-inferior way over multiple levels as the erector spinae facial plane extended from nuchal fascia cranially to the sacrum caudally [6]. Cadaveric studies have appeared that block at thoracic 5 level is adequate to have ipsilateral multidermatomal sensory block ranging from T1 to L3 [7]. This block does the purpose of a paravertebral block but erector spinae block is done without risk of pleural injury [8].…”