Erector spine plane block as a universal, safe and effective component of multimodal anesthesia




erector spine plane block, regional anesthesia, multimodal anesthesia, interfascial blocks, local anesthetics


The rapid development of evidence-based medicine in Ukraine and in the the world clearly demonstrates the effectiveness of multimodal anesthesia in the perioperative period. In addition to oral and intravenous nonsteroidal anti-inflammatory drugs, the use of regional methods of anesthesia plays a special role. The safety, efficacy of regional anesthesia and the reduction of intra- and postoperative complications are no longer in doubt. There is no anatomical area that cannot be anesthetized without the use of peripheral or central nerve blocks. However, the issue of which block as well as its anatomical basis should be used to minimize the risk for patients has to date been debatable and relevant.

The aim: to review and analyze modern sources of information in the field of anesthesiology, intensive care, and regional anesthesia; to determine the place of the ESP block among other fascial blocks and demonstrate the world experience and features of applying ESP block in different pathologies and in different surgical interventions.

The main and continuing priority in the daily work of an anesthesiologist is patient safety and the principle – “Do no harm”. A huge range of regional anesthesia methods are popular among anesthesiologists and intensivists. However, it is still unclear which one of these is as safe as it is effective.

Conclusions. ESP block is a universal, effective and relatively simple method of regional anesthesia, which effectively improves patient outcomes and reduces the number of intra- and postoperative complications.

Author Biography

M. M. Barsa, Municipal Enterprise “Rivne Regional Clinical Hospital named after Yuriy Semenyuk” Rivne Regional Council

MD, anesthesiologist of the Department of Anesthesiology and Intensive Care; PhD student, part-time Assistant of the Department of Anesthesiology and Intensive Care of the Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Ukraine


de Boer, H. D., Detriche, O., & Forget, P. (2017). Opioid-related side effects: Postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Practice & Research Clinical Anaesthesiology, 31(4), 499-504.

Helander, E. M., Billeaud, C. B., Kline, R. J., Emelife, P. I., Harmon, C. M., Prabhakar, A., Urman, R. D., & Kaye, A. D. (2017). Multimodal Approaches to Analgesia in Enhanced Recovery After Surgery Pathways. International Anesthesiology Clinics, 55(4), 51-69.

Maddali, P., Moisi, M., Page, J., Chamiraju, P., Fisahn, C., Oskouian, R., & Tubbs, R. S. (2017). Anatomical complications of epidural anesthesia: A comprehensive review. Clinical Anatomy, 30(3), 342-346.

Bhorkar, N. M., Dhansura, T. S., Tarawade, U. B., & Mehta, S. S. (2018). Epidural Hematoma: Vigilance beyond Guidelines. Indian Journal of Critical Care Medicine, 22(7), 555-557.

Wardhan, R., & Chelly, J. (2017). Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy [version 1; peer review: 3 approved]. F1000Research, 6, 2065.

Reddi, D. (2016). Preventing chronic postoperative pain. Anaesthesia, 71(S1), 64-71.

Pawa, A., Wojcikiewicz, T., Barron, A., & El-Boghdadly, K. (2019). Paravertebral Blocks: Anatomical, Practical, and Future Concepts. Current Anesthesiology Reports, 9(3), 263-270.

El-Boghdadly, K., Madjdpour, C., & Chin, K. J. (2016). Thoracic paravertebral blocks in abdominal surgery - a systematic review of randomized controlled trials. British Journal of Anaesthesia, 117(3), 297-308.

Forero, M., Adhikary, S. D., Lopez, H., Tsui, C., & Chin, K. J. (2016). The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Regional Anesthesia & Pain Medicine, 41(5), 621-627.

Dautzenberg, K., Zegers, M. J., Bleeker, C. P., Tan, E., Vissers, K., van Geffen, G. J., & van der Wal, S. (2019). Unpredictable Injectate Spread of the Erector Spinae Plane Block in Human Cadavers. Anesthesia & Analgesia, 129(5), e163-e166.

Schwartzmann, A., Peng, P., Maciel, M. A., & Forero, M. (2018). Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 65(10), 1165-1166.

Hamadnalla, H., Elsharkawy, H., Shimada, T., Maheshwari, K., Esa, W., & Tsui, B. (2019). Cervical erector spinae plane block catheter for shoulder disarticulation surgery. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 66(9), 1129-1131.

Goyal, A., Kamath, S., Kalgudi, P., & Krishnakumar, M. (2020). Perioperative analgesia with erector spinae plane block for cervical spine instrumentation surgery. Saudi Journal of Anaesthesia, 14(2), 263-264.

Diwan, S. (2019). ESRA19-0310 Bilateral ultrasound guided cervical erector spinae plane catheters for posterior cervical spine fusion. Regional Anesthesia & Pain Medicine, 44(Supl. 1), Article A209.

Ciftci, B., Ekinci, M., Celik, E. C., Tukac, I. C., Bayrak, Y., & Atalay, Y. O. (2020). Efficacy of an Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia Management After Video-Assisted Thoracic Surgery: A Prospective Randomized Study. Journal of Cardiothoracic and Vascular Anesthesia, 34(2), 444-449.

Hong, B., Bang, S., Chung, W., Yoo, S., Chung, J., & Kim, S. (2019). Multimodal analgesia with multiple intermittent doses of erector spinae plane block through a catheter after total mastectomy: a retrospective observational study. Korean Journal of Pain, 32(3), 206-214.

Ciftci, B., Ekinci, M., Gölboyu, B. E., Kapukaya, F., Atalay, Y. O., Kuyucu, E., & Demiraran, Y. (2020). High Thoracic Erector Spinae Plane Block for Arthroscopic Shoulder Surgery: A Randomized Prospective Double-Blind Study. Pain Medicine, 22(4), 776-783.

Diwan, S., & Nair, A. (2020). Erector Spinae Plane Block for Proximal Shoulder Surgery: A Phrenic Nerve Sparing Block! Turkish Journal of Anaesthesiology & Reanimation, 48(4), 331-333.

Koo, C.-H., Hwang, J.-Y., Shin, H.-J., & Ryu, J.-H. (2020). The Effects of Erector Spinae Plane Block in Terms of Postoperative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine, 9(9), Article 2928.

Hamed, M. A., Goda, A. S., Basiony, M. M., Fargaly, O. S., & Ahmed Abdelhady, M. (2019). Erector spinae plane block for postoperative analgesia in patients undergoing total abdominal hysterectomy: a randomized controlled study original study. Journal of Pain Research, 12, 1393-1398.

Ahiskalioglu, A., Tulgar, S., Celik, M., Ozer, Z., Alici, H. A., & Aydin, M. E. (2020). Lumbar Erector Spinae Plane Block as a Main Anesthetic Method for Hip Surgery in High Risk Elderly Patients: Initial Experience with a Magnetic Resonance Imaging. The Eurasian Journal of Medicine, 52(1), 16-20.

Noss, C., Anderson, K. J., & Gregory, A. J. (2019). Erector Spinae Plane Block for Open-Heart Surgery: A Potential Tool for Improved Analgesia. Journal of Cardiothoracic and Vascular Anesthesia, 33(2), 376-377.

Krishna, S. N., Chauhan, S., Bhoi, D., Kaushal, B., Hasija, S., Sangdup, T., & Bisoi, A. K. (2019). Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial. Journal of Cardiothoracic and Vascular Anesthesia, 33(2), 368-375.

Laures, E., LaFond, C., Hanrahan, K., Pierce, N., Min, H., & McCarthy, A. M. (2019). Pain Assessment Practices in the Pediatric Intensive Care Unit. Journal of Pediatric Nursing, 48, 55-62.

Macaire, P., Ho, N., Nguyen, V., Phan Van, H., Dinh Nguyen Thien, K., Bringuier, S., & Capdevila, X. (2020). Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial. Regional Anesthesia & Pain Medicine, 45(10), 805-812.

Aksu, C., & Gurkan, Y. (2019). Defining the Indications and Levels of Erector Spinae Plane Block in Pediatric Patients: A Retrospective Study of Our Current Experience. Cureus, 11(8), Article e5348.

Aksu, C., Şen, M. C., Akay, M. A., Baydemir, C., & Gürkan, Y. (2019). Erector Spinae Plane Block vs Quadratus Lumborum Block for pediatric lower abdominal surgery: A double blinded, prospective, and randomized trial. Journal of Clinical Anesthesia, 57, 24-28.

Crellin, D. J., Harrison, D., Santamaria, N., Huque, H., & Babl, F. E. (2018). The Psychometric Properties of the FLACC Scale Used to Assess Procedural Pain. The Journal of Pain, 19(8), 862-872.

Abdelhamid, K., ElHawary, H., & Turner, J. P. (2020). The Use of the Erector Spinae Plane Block to Decrease Pain and Opioid Consumption in the Emergency Department: A Literature Review. The Journal of Emergency Medicine, 58(4), 603-609.

Harbell, M. W., Seamans, D. P., Koyyalamudi, V., Kraus, M. B., Craner, R. C., & Langley, N. R. (2020). Evaluating the extent of lumbar erector spinae plane block: an anatomical study. Regional Anesthesia & Pain Medicine, 45(8), 640-644.

Celik, M., Tulgar, S., Ahiskalioglu, A., & Alper, F. (2019). Is high volume lumbar erector spinae plane block an alternative to transforaminal epidural injection? Evaluation with MRI. Regional Anesthesia & Pain Medicine, 44(9), 906-907.

Ueshima, H., Inagaki, M., Toyone, T., & Otake, H. (2019). Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study. Asian Spine Journal, 13(2), 254-257.

Singh, S., Choudhary, N. K., Lalin, D., & Verma, V. K. (2019). Bilateral Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia in Lumbar Spine Surgery: A Randomized Control Trial. Journal of Neurosurgical Anesthesiology, 32(4), 330-334.

Piraccini, E., Corso, R. M., & Maitan, S. (2019). Ultrasound guided erector spinae plane block for myofascial pain syndrome. Journal of Clinical Anesthesia, 57, Article 121.

Fusco, P., De Paolis, V., De Sanctis, F., Di Carlo, S., Petrucci, E., & Marinangeli, F. (2019). The association of erector spinae plane block and ultrasound guided dry needling could be a winning strategy for long-term relief of chronic musculoskeletal pain. Minerva Anestesiologica, 85(10), 1138-1139.

Piraccini, E., Calli, M., Taddei, S., Byrne, H., Rocchi, M., & Maitan, S. (2020). Erector spinae plane block for myofascial pain syndrome: only a short-term relief? Minerva Anestesiologica, 86(8), 888-890.

Tulgar, S., Aydin, M. E., Ahiskalioglu, A., De Cassai, A., & Gurkan, Y. (2020). Anesthetic Techniques: Focus on Lumbar Erector Spinae Plane Block. Local and Regional Anesthesia, 13, 121-133.

Restrepo-Garces, C. E., Urrego, J., Mejia-Loaiza, C., & Giraldo, L. (2019). The erector spinae plane block for radicular pain during pregnancy. International Journal of Obstetric Anesthesia, 39, 143-144.

Rahiri, J., Tuhoe, J., Svirskis, D., Lightfoot, N. J., Lirk, P. B., & Hill, A. G. (2017). Systematic review of the systemic concentrations of local anaesthetic after transversus abdominis plane block and rectus sheath block. British Journal of Anaesthesia, 118(4), 517-526.

Damjanovska, M., Stopar Pintaric, T., Cvetko, E., & Vlassakov, K. (2018). The ultrasound-guided retrolaminar block: volume-dependent injectate distribution. Journal of Pain Research, 11, 293-299.

Brown, E. N., Pavone, K. J., & Naranjo, M. (2018). Multimodal General Anesthesia: Theory and Practice. Anesthesia & Analgesia, 127(5), 1246-1258.

Yayik, A. M., Cesur, S., Ozturk, F., Ahiskalioglu, A., Ay, A. N., Celik, E. C., & Karaavci, N. C. (2019). Postoperative Analgesic Efficacy of the Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Lumbar Spinal Decompression Surgery: A Randomized Controlled Study. World Neurosurgery, 126, e779-e785.

van den Broek, R., van de Geer, R., Schepel, N. C., Liu, W. Y., Bouwman, R. A., & Versyck, B. (2021). Evaluation of adding the Erector spinae plane block to standard anesthetic care in patients undergoing posterior lumbar interbody fusion surgery. Scientific Reports, 11(1), Article 7631.

Chin, K. J., & Lewis, S. (2019). Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen. Spine, 44(6), E379-E383.

Macaire, P., Ho, N., Nguyen, T., Nguyen, B., Vu, V., Quach, C., Roques, V., & Capdevila, X. (2019). Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery - A Patient-Matched, Controlled Before-and-After Study. Journal of Cardiothoracic and Vascular Anesthesia, 33(6), 1659-1667.

Kot, P., Rodriguez, P., Granell, M., Cano, B., Rovira, L., Morales, J., Broseta, A., & Andrés, J. (2019). The erector spinae plane block: a narrative review. Korean Journal of Anesthesiology, 72(3), 209-220.



How to Cite

Barsa, M. M. (2022). Erector spine plane block as a universal, safe and effective component of multimodal anesthesia. Zaporozhye Medical Journal, 24(1), 115–122.