Tips & algorithm

 

  • A high-frequency linear transducer can be used for thoracic levels, whereas a low-frequency curved array transducer may be better suited for lumbar injections or obese patients, where the erector spinae layers are deeper (greater depth than 4cm). 
  • A caudad-to-cranial direction or out-of-plane needle insertion can be used
  • When pleura is imaged at any time: The transducer is placed too lateral. Slide medially until the transverse processes are identified and the pleura is no longer seen.
  • Keep in mind at all times: ESPB is a fascial plane technique – therefore a volume-dependent block for success. Regardless, be mindful of the total dose of local anesthetics keeping in mind the risk of local anesthetic systemic toxicity and resuscitative measures should it occur.
  • For a continuous technique, first, inject 5 mL of local anesthetic to create a space in which the catheter can then be advanced.