Erector spinae plane block

[Bsb2015]

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Anyone doing single shot ESP blocks in their practice? My colleague has just started and apparently patients are doing well. Wondering if others are having the same outcome?

 

[nvrsumr]

What do u bill that as?

 

[powermd]

I do these and bill them as a tendon sheath. Often I start low, so technically I am injecting the tendons where they attach over the sacrum.

These work well on their own about half the time. Even if there's no therapeutic benefit, they help convince the patient (and me) where the problem is. It ain't the spine if 5 mL local in the ES tendon sheaths eliminates the pain.

 

[SSdoc33]

sounds like a tpi to me.

also sounds like BS, i guess thats not the point

 

[powermd]

sounds like a tpi to me.

also sounds like BS, i guess thats not the point

Tomato, tomato.

 

[nvrsumr]

Tendon sheath pays less than tpi for some of my payors. Go figure

 

[Ducttape]

and tendon sheath injection may not be covered by some of the Medicare LCDs. TPIs are.

 

[epidural man]

YEs - have been doing them for chest wall pain. Some work, some don't.

The problem is, it works for 2 weeks (I use exparel by the way).

What are you going to do after that?

 

[Aether2000]

These are acute pain blocks, rarely work for most more than a day, and have little utility in the chronic pain population.

 

[Bsb2015]

YEs - have been doing them for chest wall pain. Some work, some don't.

The problem is, it works for 2 weeks (I use exparel by the way).

What are you going to do after that?

No steroid?

 

[Bsb2015]

These are acute pain blocks, rarely work for most more than a day, and have little utility in the chronic pain population.

Elderly female patient, chronic left sided thoracic back pain, workup otherwise negative. Esp block, 3 months worth of pain relief ‍♀️

 

[Taus]

Let’s call it what it is.... a tpi...

 

[Bsb2015]

Let’s call it what it is.... a tpi...

Thanks for the input!

 

[Aether2000]

The block is not in a muscle, but lies deep to the posterior fascia of the erector spinae muscles. It tends to spread more like an intercostal block than an intramuscular or paravertebral block, causing anesthesia of the dorsal ramus branches. The post surgical pain block lasts around 12-24 hours using bupivacaine plus dex. For it to last 3 months, it would have to work by reducing inflammation of the insertional tendons or transverse ligament or via a placebo effect.

 

[thecentral09]

Sounds like a TPI or a high volume thoracic MBB (if touching TP). I would be more interested in looking into ways facet mediated process With otherwise normal workout

 

[Ligament]

I’m curious. Nobody thought TAP blocks would be useful for lasting relief in chronic outpatient pain, yet they are..maybe the esp has such an application

 

[painfree23]

I’m curious. Nobody thought TAP blocks would be useful for lasting relief in chronic outpatient pain, yet they are..maybe the esp has such an application

How do u make them lasting in chronic pain? Also, ur blocking an actual nerve (ilioinguinal) when doing a tap block which often times u can see on u/s.

 

[Ligament]

How do u make them lasting in chronic pain? Also, ur blocking an actual nerve (ilioinguinal) when doing a tap block which often times u can see on u/s.

I do a high volume block (for outpatient settings). 20-90 cc. Dilute local for safety.

I believe chronic abdominal wall pain is due to adhesions of the abdominal wall fascia in a lot of cases (post insufflation pain, etc). The hydodissection frees up these adhesions. This is my theory, of course.

Nonetheless, seems to work well and fairly long lasting a in a lot of chronic abdominal wall pain cases.

 

[painfree23]

I do a high volume block (for outpatient settings). 20-90 cc. Dilute local for safety.

I believe chronic abdominal wall pain is due to adhesions of the abdominal wall fascia in a lot of cases (post insufflation pain, etc). The hydodissection frees up these adhesions. This is my theory, of course.

Nonetheless, seems to work well and fairly long lasting a in a lot of chronic abdominal wall pain cases.

90ccs???

 

[Ligament]

90ccs???

Yes, rarely. Very dilute local.

 

[soccrwz]

20mL of dye at T5 spreads pretty far at least C6-T12 by the anatomical study; you also get epidural spread as shown by the MRI below

[PDF] Erector Spinae Plane Block Versus Retrolaminar Block: A Magnetic Resonance Imaging and Anatomical Study | Semantic Scholar

The clinical effect of ESP and retrolaminar blocks can be explained by epidural and neural foraminal spread of local anesthetic, and the ESP block produces additional intercostal spread, which may contribute to more extensive analgesia. Background and Objectives The erector spinae plane (ESP)...

pdfs.semanticscholar.org

 

[Ligament]

I just realized we are doing ESP blocks when we do thoracic medial branch blocks, albeit small volume ESPs...

 

[callmeanesthesia]

I just realized we are doing ESP blocks when we do thoracic medial branch blocks, albeit small volume ESPs...

Wow, great point! Wonder if we could bill for a multi-level thoracic MBB by doing a fluoro-guided ESP block?