Erector Spinae Plane Block

After speaking to a colleague of mine regarding regional anesthesia for thoracotomy and mastectomy, I am reading up on Erector Spinae Plane (ESP) block.

Indications:

• Rib fractures
  • Erector spinae plane block for pain relief in rib fractures. BJA March 2017: Volume 118, Issue 3, Pages 474–475.)
  • How I Do It: Erector Spinae Block for Rib Fractures: The Penn State Health Experience. ASRA News February 2018.
  • Other blocks for Rib Fractures
• Thoracotomy/VATs
  • Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: A Case Report. A & A Case Reports. 8(10):254–256, MAY 2017.
  • The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Regional Anesthesia and Pain Medicine. Volume 41, Number 5, September-October 2016.
  • The Ultrasound-Guided Continuous Erector Spinae Plane Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Lobectomy. Regional Anesthesia and Pain Medicine: July/August 2017 – Volume 42 – Issue 4 – p 537.

  • 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. Indian J Anaesth. 2018 Jan; 62(1): 75–78.

• Esophagectomy
  • Erector spinae plane block as a multiple catheter technique for open esophagectomy: a case report.  Rev Bras Anestesiol. 2018; xxx(xx): xxx—xxx.
• Mastectomy/Breast reconstruction
  • Continuous erector spinae plane block
    provides effective perioperative analgesia for breast reconstruction using tissue expanders: A report of two cases. Journal of Clinical Anesthesia 44(2018)1-2.

  • The Erector Spinae Plane Block Provides Complete Surgical Anesthesia in Breast Surgery.  A Case Report. A&A Practice: October 1, 2018 – Volume 11 – Issue 7 – p 186–188

• Abdominal surgery
  • Continuous Erector Spinae Plane (ESP) Analgesia In Different Open Abdominal Surgical Procedures: A Case Series. Journal of Anesthesia and Surgery. https://doi.org/10.15436/2377-1364.18.1853.

  • Bilateral Continuous Erector Spinae Plane Block Contributes to Effective Postoperative Analgesia After Major Open Abdominal Surgery: A Case Report. A&A Practice: December 1, 2017 – Volume 9 – Issue 11 – p 319–321

  • The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia, Volume72, Issue4. April 2017. Pages 452-460.

  • Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study. Anesthesia & Analgesia: July 2019 – Volume 129 – Issue 1 – p 235-240

• Cardiac surgery
  • Continuous Erector Spinae Plane (ESP) Block for Postoperative Analgesia after Minimally Invasive Mitral Valve Surgery. October 2018Volume 32, Issue 5, Pages 2271–2274.
  • Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery.  Ann Card Anaesth 2018;21:323-7.
  • Bilateral Continuous Erector Spinae Plane Blocks for Median
    Sternotomy in a Pediatric Cardiac Patient.  ASRA World 2018 Poster.

Continuous Peripheral Nerve Catheters – What is the Current Thinking? March 2015 PPT.

Other regional blocks

Continuous ESP block catheter (my current regimen and what I’m able to get at my institution):

• Braun Periflex catheter through 17g epidural needle
• Cranial-to-caudal approach @ T5 (mastectomy, vats, rib fractures)
• 20ml 0.25% bupi + epi prior to catheter
• Catheter 5cm in space
• 5 ml 0.25% bupi + epi after catheter placed
• Mix: 0.125% bupi + fentanyl @ 10 ml/hr
• If PCEA available, bolus 15ml every 3 hours; continuous as mix above.

Traveling with an Infant

We took our first trip as a family of 3 to Maui (or should I say 4 since I’m 14 weeks pregnant).  Granted, it’s a roughly 6 hour/5 hour plane ride to/back.  I had read up on multiple blogs regarding what to bring, how to travel, what to expect, etc.  I’ve created a bullet list of must-have things to travel with or pack for your little one (ours was 7 months old at the time of travel)