In this video, we discuss the anatomy, mechanism, and technique for thoracic and lumbar ESP block, and share some tips for success when performing this block
Thank you-your vídeos are extremely well done and your tips and pearls are helpful and pertinent to actual practice-other video producers should learn from you!
Excellent video on ESP. This general technique is also helpful in interventional treatments for chronic pain (eg. thoracic facet syndrome/ costotransverse joint pathology).
If the TP is difficult to visualize, but the rib slightly lateral to the TP is super easy to see, if you choose to inject instead on top of the rib, how effective would this be? Would you block dorsal rami and miss the paravertebral space spread? Or would you get roughly equal efficacy compare to ESP?
Is the erector spinar plane continuous to the retrolaminar region more medially? If so, would placement of a retrolaminar block also work just about as well with lesser chance of penetrating past bone since the laminae provide a continuous row of bone with much smaller gaps? You would simply stay closer to midline. I've read about use of retrolaminar block in pain clinic but never as applied for postop pain. Thanks
How long does analgesia after a single shot last? Do you use any adjunctive meds to enhance quality and prolong duration of the block? Would you use Exparel with this block? Thank you!
Actually this is paravertebral block. because ES muscle is supplied by dorsal rami. How come blocking Dorsal rami you can block the pain from the structures which are supplied by ventral rami. So, anatomically you are definitely blocking both the rami. That's why it's better to say paravertebral block. Better to give epidural to get better effect with less dose. Can you achieve the same effect giving 5ml in ES block which is possible with that less dose in epidural?
Thanks for your insightful comments! Yes, agree, one of the proposed mechanisms for how the ESP block works is spread of local anesthetic to the ventral (anterior) side of the transverse process, which is essentially the paravertebral space. Some have called this the "paravertebral by proxy". There are still lots of unanswered questions about volume and dosing. For example, if I put 5 ml in the true paravetebral space, I can definitely expect to get a dense block of that nerve root (both rami). I don't believe 5 mL placed as an ESP block would do that...which is why we use so much volume in ESP blocks. Thanks for watching!
Thank you-your vídeos are extremely well done and your tips and pearls are helpful and pertinent to actual practice-other video producers should learn from you!
Excellent tutorial, great visuals and narration!
Excellent teacher . Great presentation
Great presentation. Well done
Love that smoke narration!
Excellent presentation
Excellent video and very well explained
Excellent video on ESP. This general technique is also helpful in interventional treatments for chronic pain (eg. thoracic facet syndrome/ costotransverse joint pathology).
Very helpful thank you so much
ESP block is Darling ...One Block covers everything.
So beautiful.
Did u hv experience ESP for lower limb surgeries?
Excellent video presentation Sir.
Make us fall in love with ESP in just 8minutes
Thanks a tonne Sir
great video
I had no idea the ESP was useful for abdominal surgery... Very cool! Thanks!
I've done ESP for laparotomy n bowel resection.. I would say, excellent as I didn't give any morphine intra-op
@@tazkirah88may i know how much volume and drug concentrations you usually use? thank you
Show! 👏🏾 👏🏾 👏🏾 👏🏾
thanks
Thanks for the informative video. For pancreatitis pain relief which side should be blocked?
will it be also effective for chest wall lesion post-herpetic neuralgia?
Sir can you make videos on newer Sacral ESP and Cervical ESP blocks?? It'll be a lot of help to us Sir
If the TP is difficult to visualize, but the rib slightly lateral to the TP is super easy to see, if you choose to inject instead on top of the rib, how effective would this be? Would you block dorsal rami and miss the paravertebral space spread? Or would you get roughly equal efficacy compare to ESP?
Perfect
Thanks!! Appreciate you watching!
Is the erector spinar plane continuous to the retrolaminar region more medially? If so, would placement of a retrolaminar block also work just about as well with lesser chance of penetrating past bone since the laminae provide a continuous row of bone with much smaller gaps? You would simply stay closer to midline. I've read about use of retrolaminar block in pain clinic but never as applied for postop pain. Thanks
Do u have any experience using ESP for lower limb surgeries? Especially ESP as whole anaesthesia, not as analgesia?
how is your needle visualised so well at that angle with the lumbar example?
My toughts exactly.. what type of needle is that
I think the curvilinear probe certainly helps
Would an L3 block work for sciatica pain?
How long does analgesia after a single shot last? Do you use any adjunctive meds to enhance quality and prolong duration of the block? Would you use Exparel with this block? Thank you!
Olso I’m interested to this answer!
Is ESP worth as single shot? How long does the analgesia last without a catheter?
Thank you very clear and informative!
Have you used exparel for Thoracic level ESP blocks? Any issues of Exparel or marcaine behaving like an epidural?
Beautiful presentation... Just a question?? Why is that the needle not that clearly visible ??
Have you been administering bilateral blocks for, say, non-robotic (!) open abdominal surgery?
I've done it for open midline laparotomy. Good visceral pain coverage too, no morphine required intra-op.
After an ESPB how long until you can drive?
Sir can you share some reference articles where 30ml volume spreads to 8 Thoracic levels and 4 Lumbar levels is mentioned??
Thanks in advance Sir
@@regionalanesthesiology Thank you very much Sir
Which probe and which machine is that? Specifically which curvilinear probe and which linear probe? Our curvilinear looks nowhere near that clear
Actually this is paravertebral block. because ES muscle is supplied by dorsal rami. How come blocking Dorsal rami you can block the pain from the structures which are supplied by ventral rami. So, anatomically you are definitely blocking both the rami. That's why it's better to say paravertebral block. Better to give epidural to get better effect with less dose. Can you achieve the same effect giving 5ml in ES block which is possible with that less dose in epidural?
Thanks for your insightful comments! Yes, agree, one of the proposed mechanisms for how the ESP block works is spread of local anesthetic to the ventral (anterior) side of the transverse process, which is essentially the paravertebral space. Some have called this the "paravertebral by proxy". There are still lots of unanswered questions about volume and dosing. For example, if I put 5 ml in the true paravetebral space, I can definitely expect to get a dense block of that nerve root (both rami). I don't believe 5 mL placed as an ESP block would do that...which is why we use so much volume in ESP blocks. Thanks for watching!
In upper abdominal surgery, we inject at T7 level. I see colleges inject at multiple levels. Any comments?
Thank you for detailed explanation.