Erector spinae plane block in children: a narrative review

Abstract

The erector spinae plane block (ESPB) is a novel technique used in both adult and pediatric patients. Its use in children has mostly been described in terms of perioperative pain management for various types of surgery. After its introduction, anesthesiologists began using ESPBs in various surgical settings. As adequate analgesia along with a low complication rate were reported, interest in this technique dramatically increased. Many studies in adults and children, including randomized controlled trials, have been published, resulting in the emergence of different clinical indications, with various technical and pharmacological approaches currently evident in the literature. This narrative review aims to analyze the current evidence in order to guide practitioners towards a more homogeneous approach to ESPBs in children, with a major focus on clinical applications. The ESPB is an efficient, safe, and relatively easy technique to administer. It can be applied in a wide range of surgeries, includes thoracic, abdominal, hip, and femur surgery. Its usefulness is evident in the context of enhanced recovery after surgery protocols and multimodal analgesia. Single-shot, intermittent bolus, and continuous infusion techniques have been described, and non-inferiority has been observed when compared with other locoregional techniques. Even though both the efficacy and safety of the procedure are widely accepted, current evidence is predominantly based on case reports, with very few well-designed observational studies. Consequently, the level of evidence is still poor, and more well-designed double-blind, randomized, placebo-controlled trials are needed to refine the procedure for different clinical applications in the pediatric population.

Keywords: Analgesia; Anesthesia; Child; Conduction anesthesia; Nerve block; Newborn infant; Review..

Fig. 1.

(A) The ultrasound probe is placed along the midline of the spine and moved laterally to visualize the transverse process. (B) The needle advances to the tip of the transverse process, and LA is injected to dissect the plane deep to the erector spinae muscle.