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Erector Spinae Plane Block
Aka: Erector Spinae Plane Block, Ultrasound-Guided Erector Spinae Block, Erector Spinae Nerve Block, Spinous Erectus Nerve Block
- See Also
- Regional Anesthesia
- Serratus Anterior Nerve Block
- Background
- Newly described trunk Regional Anesthesia as of 2016
- May be preferred over Serratus Anterior Nerve Block and Intercostal Nerve Block
- Indications
- Chest wall Anesthesia
- Chest wall injury (e.g. Rib Fracture, transverse process Fracture)
- Incomplete coverage for Chest Tube placement
- Provides Anesthesia for the chest wall, but not the pleura
- Anatomy
- Erector Spinae are a constellation of 3 Muscle groups (each containing 3 Muscles)
- Medial Muscles (Three spinalis Muscles)
- Intermediate Muscles (Three longissimus Muscles)
- Lateral Muscles (Three iliocostalis Muscles)
- Erector Spinae Muscles provide a tissue plane for Anesthesia to the hemithorax, chest wall
- Vertebral transverse process provides a convenient needle backstop for the tissue plane for injection
- Preparation
- Identify and mark landmarks
- Midline Thoracic Back (spinous processes)
- Fourth Thoracic Vertebrae (T4) - just below Scapular spine which is at T3 level
- Skin Preparation (e.g. Chlorhexidine)
- Drape region
- Sterile covering over Ultrasound high frequency linear probe (sterile gel inside and outside)
- Medication
- Confirm maximum dose for Ropivacaine (or Bupivacaine ) to prevent LAST Reaction
- Ropivacaine 0.2 to 0.375% (preferred over Bupivacaine 0.25%) 20-30 ml
- Syringe 30 ml
- Needle 22 gauge, 2-4" (5-10 cm)
- Technique
- Images

- Patient typically in seated position
- Ultrasound in vertical plane over midline Thoracic Spine
- High frequency linear probe
- Top of probe at T4 Vertebrae spinous process, in midline
- Ultrasound image should show several transverse processes to confirm vertical plane
- Injection site will be be ~2 cm lateral to midline overlying transverse process
- Midline spinous process (superficial rounded appearance)
- Lamina (deeper flat appearance)
- Transverse Process (superficial flat appearance) - Target Site
- Pleura should NOT be visualized
- Rib (deeper rounded appearance)
- Pleura and Sliding Lung Sign will be seen between ribs
- Injection Plane
- Inject from superior to inferior in line with transverse processes
- Down to level of transverse process (serves as backstop for needle)
- Target is space below the erector spinae Muscle
- References
- Krishnan and Cascella (2020) Erector Spinae Plane Block, Stat Pearls, accessed 12/21/2020
- https://www.ncbi.nlm.nih.gov/books/NBK557382/
- Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
- https://stabroom.com/
- Erector Spinae Plane Block, NYSORA, accessed 12/21/2020
- https://nysoralms.com/courses/erector-spinae-plane-block/