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

Sanjib Das Adhikary, Ashlee Pruett, Mauricio Forero, Venkatesan Thiruvenkatarajan, Sanjib Das Adhikary, Ashlee Pruett, Mauricio Forero, Venkatesan Thiruvenkatarajan

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.

Keywords: Erector spine block; epidural analgesia; local anaesthetic spread; video-assisted thoracoscopic surgery.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The injection of 20 ml of contrast material at T5 demonstrating the craniocaudal spread between the levels of the T3 and L1 transverse processes (arrows) on the right side. There was lateral spread to the lateral aspect of the erector spinae muscle and slightly beyond into the intercostal spaces at the T7 to T9 levels. There was medial spread as far as the medial border of the erector spinae muscle. Contrast was noted on both the anterior and posterior surfaces of erector spinae muscle

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