title: The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain.
abstract: Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit of interventional nerve block procedures is unclear due to a paucity of evidence and the invasiveness of the described techniques. In this report, we describe a novel interfascial plane block, the erector spinae plane (ESP) block, and its successful application in 2 cases of severe neuropathic pain (the first resulting from metastatic disease of the ribs, and the second from malunion of multiple rib fractures). In both cases, the ESP block also produced an extensive multidermatomal sensory block. Anatomical and radiological investigation in fresh cadavers indicates that its likely site of action is at the dorsal and ventral rami of the thoracic spinal nerves. The ESP block holds promise as a simple and safe technique for thoracic analgesia in both chronic neuropathic pain as well as acute postsurgical or posttraumatic pain.
authors: From the *Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Departments of †Anesthesiology and Perioperative Medicine, and ‡Orthopedic Surgery and Radiology, Penn State Hershey College of Medicine, Hershey, PA; §Michael G. DeGroote School of Medicine, McMaster University, Hamilton; and ∥Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.
authors: Mauricio
authors: M
authors: Forero
authors: Sanjib D
authors: SD
authors: Adhikary
authors: Hector
authors: H
authors: Lopez
authors: Calvin
authors: C
authors: Tsui
authors: Ki Jinn
authors: KJ
authors: Chin
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000698:Analgesia / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002102:Cadaver; D002637:Chest Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D004210:Dissection; D004338:Drug Combinations; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D011788:Quality of Life; D020127:Recovery of Function; D000077212:Ropivacaine; D013900:Thoracic Nerves / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D004338:Drug Combinations; D000077212:Ropivacaine; D008012:Lidocaine; D002045:Bupivacaine