The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain

Reg Anesth Pain Med. Sep-Oct 2016;41(5):621-7. doi: 10.1097/AAP.0000000000000451.

Abstract

Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit of interventional nerve block procedures is unclear due to a paucity of evidence and the invasiveness of the described techniques. In this report, we describe a novel interfascial plane block, the erector spinae plane (ESP) block, and its successful application in 2 cases of severe neuropathic pain (the first resulting from metastatic disease of the ribs, and the second from malunion of multiple rib fractures). In both cases, the ESP block also produced an extensive multidermatomal sensory block. Anatomical and radiological investigation in fresh cadavers indicates that its likely site of action is at the dorsal and ventral rami of the thoracic spinal nerves. The ESP block holds promise as a simple and safe technique for thoracic analgesia in both chronic neuropathic pain as well as acute postsurgical or posttraumatic pain.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amides / administration & dosage*
  • Analgesia / methods*
  • Anesthetics, Combined / administration & dosage*
  • Anesthetics, Local / administration & dosage*
  • Bupivacaine / administration & dosage*
  • Cadaver
  • Chest Pain / diagnosis
  • Chest Pain / drug therapy*
  • Chest Pain / physiopathology
  • Dissection
  • Drug Combinations
  • Humans
  • Lidocaine / administration & dosage*
  • Male
  • Middle Aged
  • Nerve Block / methods*
  • Neuralgia / diagnosis
  • Neuralgia / drug therapy*
  • Neuralgia / physiopathology
  • Pain Measurement
  • Quality of Life
  • Recovery of Function
  • Ropivacaine
  • Thoracic Nerves / diagnostic imaging
  • Thoracic Nerves / drug effects*
  • Thoracic Nerves / physiopathology
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Interventional

Substances

  • Amides
  • Anesthetics, Combined
  • Anesthetics, Local
  • Drug Combinations
  • Ropivacaine
  • Lidocaine
  • Bupivacaine