Page 6 - CASA Bulletin of Anesthesiology 2019 Vol 6 No 5

CASA Bulletin of Anesthesiology

Clinical Application:
The clinical efficacy of the ESP block has been confirmed in a wide range of clinical scenar-
ios from abundant case reports as well as a few randomized controlled trials . A pooled review
of 242 cases [5] found that the block has been performed at cervical, thoracic and lumbar levels
for both acute and chronic pain in both adult and pediatric patients . In the majority of the cases,
ESP block was used for postoperative analgesia as part of multimodal pain management .

The reported surgical indications include thoracic (e .g . rib fracture, breast surgery, and car-
diac surgery), abdominal (e .g . ventral hernia repair, bariatric surgery, hepatectomy, cholecystec-

tomy), urological (e .g . nephrectomy/pyeloplasty, and radical retropubic prostatectomy), gyne-
cological (e .g . hysterectomy), spinal surgery, as well as orthopedic procedures including upper
and lower limb surgeries . Although less frequently reported, ESP block for chronic pain has also
been described to be effective in cases of frozen shoulder, interscapular myofascial pain, and
neuropathic pain . Due to its short history, the potential use of the ESP block in acute and chron-
ic analgesia could be expanded further to the procedures and conditions not yet considered .

To date, nine prospective randomized controlled trials evaluating the postoperative analgesic
efficacy of ESP block have been published. The surgical procedures studied include breast sur-

geries [6–8], cardiac surgeries [9, 10], laparoscopic cholecystectomy [11, 12], epigastric hernia
repair [13], and hip and proximal femur surgery [14]. When compared with a control group with
no block or sham blocks, the ESP block group typically showed superior analgesia manifest-
ed with significant reduction in one or more following measures: Numeric Rating Scale pain
scores, opioid consumption, or number of patients required rescue analgesia . ESP block has also
been shown non-inferior to or better than the following regional techniques: tumescent anes-
thesia in reduction mammoplasty [7], thoracic epidural in cardiac surgery [9], oblique subcostal
transversus abdominis plane block in laparoscopic cholecystectomy [11], and transmuscular
quadratus lumborum block in hip and proximal femur surgery [14]. The non-inferiority to tho-
racic epidural is especially noteworthy, as ESP block is postulated to have better safety profile
and less contraindications (see below). There is only one trial [3] that revealed a less effective

analgesic profile of ESP block in comparison to modified pectoral nerve block (PECS) for radi-
cal mastectomy .

Clinical trials and case reports have revealed few complications or side effects that could be
attributed to the ESP block, which is not a surprise in considering its unique advantages com-
pared to the other regional blockades, such as epidural or paravertebral blocks . First, the needle
insertion site is anatomically away from major blood vessels, spinal cord, pleura or discrete
nerves . Serious complications such as epidural hematoma or abscess and spinal cord injury are
in theory unlikely to happen with this block . Second, ESP block is technically easy to perform

with a superficial anatomical target. Finally, ESP block has few contraindications. A chart re-
view of 182 patients who underwent ESP block in a single center revealed complications in 4
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