Incidentally Identified Posterior Intercostal Artery on the Interfascial Plane Between Transverse Process

Abstract

ince being first defined, erector spinae plane block (ESPB) has been described as being "safer" by various authors, owing to its distance from neural and vascular tissues and its relatively low reported complication rates. 1,2 Although a PubMed search reveals over 900 papers on ESPB as of March 2022, these papers report very few complications. All complications of ESPB such as motor block, the spread of local anesthetic (LA) to the opposite side, priapism, and Harlequin syndrome are related to the spread of LA to the paravertebral space and the sympathetic chain. 3 However, Yawata et al 4 reported LA systemic toxicity (LAST) following ESPB. Karaca et al 5 also reported LAST following lumbar ESPB. Although both authors state that they are the first to report LAST secondary to ESPB, a case with two major (aphasia/apathy and short lasting loss of consciousness) and one minor (vertigo/tinnitus) component of LAST has been previously reported.Yawata et al and Karaca et al presented cases of LAST with no cardiovascular instability where major neurological findings with seizures were observed. 4,5 In the first case, where the patient's demographic information such as weight and height are not reported, a total of 40 mL LA (20 mL of bupivacaine, 10 mL of lidocaine,