Lumbar versus thoracic erector spinae plane block: Similar nomenclature, different mechanism of action

• Published in: Journal of clinical anesthesia Vol. 48; p. 1
• Main Authors: Kose, Halil Cihan, Kose, Selin Guven, Thomas, David Terence
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2018; Elsevier Limited
• Subjects: Anesthetics, Local - administration & dosage; Humans; Nerve Block - methods; Neuralgia - drug therapy; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Paraspinal Muscles - diagnostic imaging; Paraspinal Muscles - innervation; Surgical Procedures, Operative - adverse effects; Ultrasonic imaging; Ultrasonography, Interventional
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2018.03.026

The boundaries of the paravertebral spaces are the vertebral body and intervertebral foramen medially, the pleura anterolaterally, costotransverse ligament posteriorly and internal intercostal membrane laterally. [...]the spread of even small volumes of LA in thoracic ESPB, effects both the ventral and dorsal rami in several levels, leading to multilevel analgesia. [...]the paravertebral area does not have such clear boundaries in the lumbar area. [...]when ESPB is performed as described by Tulgar et al. Thoracic ESPB Lumbar ESPB Site of needle insertion 2–2.5 cm lateral of midline 4–5 cm lateral of midline Distance between skin and transverse process 2–3 cm 4–6 cm, sometimes more Ultrasonography transducer Linear transducer sufficient Generally requires convex transducer Visualisation of local anesthetic spread Clearly seen on ultrasonography Generally not visualised Spread of local anesthetic In paravertebral space leading to multilevel analgesia Mostly around lumbar plexus, less so in paravertebral space Ease of application Easier Requires more experience Table 1 Various differences between thoracic and lumbar erector spinae plane block.