Erector Spinae Plane (ESP) Block: a New Paradigm in Regional Anesthesia and Analgesia

Abstract

The erector spinae plane (ESP) block is an ultrasound-guided regional anesthesia technique that has enjoyed unprecedented popularity since its description in 2016. This review summarizes the applied anatomy, technical performance, and clinical application of the ESP block. Dissection and imaging studies indicate that paravertebral local anesthetic spread is a primary mechanism of action of the ESP block. A large volume of case report literature supports its efficacy in myriad clinical settings, including thoracic surgery, thoracic trauma, cardiac surgery, abdominal surgery, spine surgery, and painful conditions of the upper and lower limbs. Several randomized controlled trials have also been published that report significant analgesic benefit compared with systemic analgesia alone. The ESP block is a highly effective and versatile technique for the management of acute and chronic pain. Further studies are needed to definitively determine its efficacy compared with more established techniques.