ESP block

[anes121508]

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Seeing more and more in the literature.

Several nice benefits.

Used it again today:
surgeon unexpectedly opened up a lap choley and pt had huge incision just under rib cage and I wasn’t sure if TAPS would do it.

0/10 pain in pacu. Even witnessed him cough without flinching a bit and ask for more ice chips.

Other cases I’ve used it in: thoracotomy (lung, lvad, mini mitral), mastectomy, combined open liver + bowel resection

Are you guys incorporating this more?
Has it gained any popularity recently where you are?
When are you using it?

 

[anbuitachi]

when did you do it and how? turned patient lateral? prone? sat patient up? did it after extubation or prior?

 

[Lecithin5]

I love this block. Mainly for rib fx pts where I'm not comfy doing neuraxial due to anticoag issues or when I don't think serrarus plane would cover it.

 

[jope]

I have used it for all of my VATS cases now and even with a catheter sometimes. Though it definitely seems once the initial bolus wears off, the catheter infusion is not as effective.

I have not used it for abdominal cases yet. Which level do you normally go for?

 

[vector2]

Similar to other plane blocks I think you really need a pump capable of basal intermittent bolus for the catheter to be particularly effective

 

[Nargosi]

Did one of these at T1 in Kenya for a forequarter amputation. Pt did great through POD1 which was as long as I got to follow. Really a cool block.

 

[MaximusD]

If seeking continuous coverage with a catheter, intermittent bolus is a must due to the vascular nature of the plane.

At my institution, we typically do ropi 0.2% 20mL-30mL q3h. Continuous infusion is less-than-desirable, so take-home Q-pumps are not the best. We send our patients home with Nimbus pumps. FWIW/YMMV.

 

[USCTrojan11]

If seeking continuous coverage with a catheter, intermittent bolus is a must due to the vascular nature of the plane.

At my institution, we typically do ropi 0.2% 20mL-30mL q3h. Continuous infusion is less-than-desirable, so take-home Q-pumps are not the best. We send our patients home with Nimbus pumps. FWIW/YMMV.

100% agree - the infusions we run have been nearly useless. If you think about how LA is absorbed and how this 12 mL/hour is really 1 mL q 5 mins, it seems silly to expect that to distend and spread the potential space that is the Erector Spinae plane.

I'm a huge fan of this block and it seemed to be a focus at ASRA last week

 

[USCTrojan11]

I have used it for all of my VATS cases now and even with a catheter sometimes. Though it definitely seems once the initial bolus wears off, the catheter infusion is not as effective.

I have not used it for abdominal cases yet. Which level do you normally go for?

For abdominal, depends on the case but ideally want to cover T4-T10. So go for T6/T7 bilaterally and 30 mL ea