Erector Spinae Plane Block and Chronic Pain: An Updated Review and Possible Future Directions

Abstract

Chronic pain is a common, pervasive, and often disabling medical condition that affects millions of people worldwide. According to the Global Burden of Disease survey, painful chronic conditions are causing the largest numbers of years lived with disability worldwide. In America, more than one in five adults experiences chronic pain. Erector spinae plane block is a novel regional anesthesia technique used to provide analgesia with multiple possible uses and a relatively low learning curve and complication rate. Here, we review the erector spinae plane block rationale, mechanism of action and possible complications, and discuss its potential use for chronic pain with possible future directions for research.

Keywords: anesthesia; chronic pain; conduction anesthesia; review.

Figure 1

Graphic representation of ESP block. Under ultrasound guidance, the needle is advanced between the erector spinae muscle group and transverse process; after contact with the bone, the local anesthetic can be injected.

Figure 2

Sonoanatomy of ESP block. TM: Trapezius Muscle; RM: Rhomboid Muscle; ESM: erector spinae group muscle; TP: transverse process; *: target.

Figure 3

Coronal view of magnetic resonance imaging of two patients receiving ESP block with a 30 mL volume (gadolinium). Vascular uptake is shown with black arrows in panel (A) and with white arrows in panel (B). The images are unpublished material from a previously published study [36]; images are reproduced by courtesy of Marie Sørenstua.