🧠 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.

<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:

1. T5 for thoracic analgesia
2. T7–T9 for abdominal analgesia

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<fold Ultrasound-Guided Procedure> - Position: Sitting, lateral decubitus, or prone. - Ultrasound: High-frequency linear probe to visualize:

1. Skin
2. Subcutaneous tissue
3. Erector spinae muscle
4. 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. </fold>

</tab> <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

</tab> <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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