In this video, we discuss the anatomy, mechanism, and technique for thoracic and lumbar ESP block, and share some tips for success when performing this block
Thank you-your vídeos are extremely well done and your tips and pearls are helpful and pertinent to actual practice-other video producers should learn from you!
Excellent video on ESP. This general technique is also helpful in interventional treatments for chronic pain (eg. thoracic facet syndrome/ costotransverse joint pathology).
If the TP is difficult to visualize, but the rib slightly lateral to the TP is super easy to see, if you choose to inject instead on top of the rib, how effective would this be? Would you block dorsal rami and miss the paravertebral space spread? Or would you get roughly equal efficacy compare to ESP?
How long does analgesia after a single shot last? Do you use any adjunctive meds to enhance quality and prolong duration of the block? Would you use Exparel with this block? Thank you!
Is the erector spinar plane continuous to the retrolaminar region more medially? If so, would placement of a retrolaminar block also work just about as well with lesser chance of penetrating past bone since the laminae provide a continuous row of bone with much smaller gaps? You would simply stay closer to midline. I've read about use of retrolaminar block in pain clinic but never as applied for postop pain. Thanks
Actually this is paravertebral block. because ES muscle is supplied by dorsal rami. How come blocking Dorsal rami you can block the pain from the structures which are supplied by ventral rami. So, anatomically you are definitely blocking both the rami. That's why it's better to say paravertebral block. Better to give epidural to get better effect with less dose. Can you achieve the same effect giving 5ml in ES block which is possible with that less dose in epidural?
Thanks for your insightful comments! Yes, agree, one of the proposed mechanisms for how the ESP block works is spread of local anesthetic to the ventral (anterior) side of the transverse process, which is essentially the paravertebral space. Some have called this the "paravertebral by proxy". There are still lots of unanswered questions about volume and dosing. For example, if I put 5 ml in the true paravetebral space, I can definitely expect to get a dense block of that nerve root (both rami). I don't believe 5 mL placed as an ESP block would do that...which is why we use so much volume in ESP blocks. Thanks for watching!
