53.7 Tips & algorithm

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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.