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

Serkan Tulgar, Ali Ahiskalioglu, Alessandro De Cassai, Yavuz Gurkan, Serkan Tulgar, Ali Ahiskalioglu, Alessandro De Cassai, Yavuz Gurkan

Abstract

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.

Keywords: bilateral erector spinae block; interfascial plane blocks; regional anesthesia.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Tulgar et al.

Figures

Figure 1
Figure 1
Illustration of results of anatomical and imaging studies related to erector spinae plane block. Notes: (A) Demonstration of anatomic structures. (B) Spread of injectant in Schwartzman et al. (C) Spread of injectant in Ivanusic et al. (D) Spread of injectant in Yang et al. (E) Spread of injectant in Adhikary et al. (F) Spread of injectant in Vital et al. Dark blue, obvious spread of injectant, Light blue (D, F), little spread of injectant. Green triangle, paravertebral space. Abbreviations: TM, trapezius muscle; RMM, rhomboid major muscle; ESM, erector spinae muscle; TP, transverse process; SP, spinous process; VB, thoracic vertebral body.
Figure 2
Figure 2
(A) Position and orientation of the ultrasound transducer during a parasagittal scan of the upper thoracic region with the subject in the prone position. (B) Parasagittal ultrasound image of upper thoracic erector spinae plane block (ESPB). (C) Position and orientation of the ultrasound transducer during a transverse scan of the upper thoracic region with the subject in the prone position. (D) Transverse ultrasound image of upper thoracic ESPB. White arrow indicates needle. Abbreviations: T4, thoracic 4 vertebrae transverse process; TM, trapezius muscle; RMM, rhomboid major muscle; ESM, erector spinae muscle; ICM, intercostal muscle.
Figure 3
Figure 3
(A) Position and orientation of the ultrasound transducer during a parasagittal scan of the mid-thoracic region with the subject in the prone position. (B) Parasagittal ultrasound image of mid-thoracic erector spinae plane block. White arrow indicates needle. Abbreviations: T, transverse process; TM, trapezius muscle; ESM, erector spinae muscle; ICM, intercostal muscle.
Figure 4
Figure 4
(A) Position and orientation of the ultrasound transducer during a median transverse scan of the mid-thoracic region at the level of spinous process by Yorukoglu approach. (B) Transverse ultrasound image of the mid-thoracic bilateral erector spinae plane block. White arrow indicates needle. Abbreviations: TP, transverse process; SP, spinous process.
Figure 5
Figure 5
(A) Position and orientation of the curvilinear ultrasound transducer during a transverse scan of the lumbar region above the iliac crest with the subject in the lateral decubitus position. (B) Ultrasound images of shamrock sign and Aksu/Cassai approaches for erector spinae plane block in the posterior axillary line above the iliac crest. White arrow indicates needle. Abbreviations: TP, transverse process; QLM, quadratus lumborum muscle; ESM, erector spinae muscle; PM, psoas muscle; VB, vertebral body.
Figure 6
Figure 6
(A) Position and orientation of the ultrasound transducer during a parasagittal scan of the lumbar region with the subject in the prone position. (B) Ultrasound images of Tulgar approach for lumbar erector spinae plane block. White arrow indicates needle with in-plane approach. Abbreviations: TP, transverse process; ESM, erector spinae muscle; PM, psoas muscle.

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