🧠 Erector Spinae Plane (ESP) Block [Neurosurgery Wiki]

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====== 🧠 Erector Spinae Plane (ESP) Block ======

**Overview:** The ESP block is an interfascial regional anesthesia technique that provides thoracic and abdominal analgesia. It has gained popularity due to its ease of use, safety profile, and effectiveness.

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<tabs>
<tab TECHNIQUE>

<fold Anatomy and Landmarking>
- The erector spinae muscles lie over the transverse processes of the vertebrae.
- The target injection point is **deep to the erector spinae muscle**, just superficial to the **transverse process**.
- Common levels:  
  - **T5** for thoracic analgesia  
  - **T7–T9** for abdominal analgesia  
</fold>

<fold Ultrasound-Guided Procedure>
- **Position**: Sitting, lateral decubitus, or prone.
- **Ultrasound**: High-frequency linear probe to visualize:
  - Skin
  - Subcutaneous tissue
  - Erector spinae muscle
  - Transverse process (hyperechoic line)
- **Needle**: In-plane approach toward the transverse process.
- **Injection**: 20–30 mL of local anesthetic (e.g., ropivacaine 0.25–0.5%) after hydrodissection confirms correct plane.
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<tab INDICATIONS>

- Thoracic trauma (e.g. rib fractures)
- Video-assisted thoracoscopic surgery (VATS)
- Breast surgery
- Abdominal surgery (e.g. hernia repair, laparoscopic procedures)
- Spine surgery
- Chronic thoracoabdominal pain

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<tab ADVANTAGES>

<fold Why choose ESP block?>
- Easy to perform with ultrasound guidance
- Lower risk of complications compared to epidural or paravertebral block
- Can be used in anticoagulated patients (relative)
- Provides both somatic and visceral analgesia
</fold>

</tab>
<tab COMPLICATIONS>

- Block failure
- Local anesthetic systemic toxicity (LAST)
- Infection or hematoma (rare)
- Inadequate spread in some patients

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</tabs>

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📌 **Tags**: regional anesthesia, ESP block, ultrasound, pain management, interfascial plane
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