Erector spinae fascia block

 

Performance:

Position

·      Sitting upright

Needle

·      Tuohy + catheter

Probe

·      Longitudinal

·      Parasagittal 3cm from midline

Looking for

·      Layers of muscle: trapezius + rhomboid + erector spinae + rotators

·      Transverse processes

Target

·      Fascial plane deep to erector spinae

·      Approx at depth of transverse process

Volume

·      20mL effective for 3-4 spinal levels

 

Evaluation:

Use

·      Rib fractures

·      Spine surgery

·      Thoracic surgery

Mechanism

·      Paravertebral by proxy

·      Drug spread through costotransverse foramen

Pros

·      Easy

·      Safe

·      Ok even if anticoagulated

Cons

·      Iffy anatomical basis

·      No good large trials yet

 

 

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