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The erector spinae plane block is an ultrasound-guided regional anesthesia technique that has gained attention for its simplicity, safety profile, and versatility in managing acute and chronic pain. While initially described as a single-injection block, the placement of an erector spinae plane catheter has expanded its utility, providing extended analgesia for a wide range of surgical procedures, including thoracic, abdominal, and orthopedic interventions. This educational activity presents an overview of the erector spinae plane catheter technique, including anatomical considerations, ultrasound-guided approaches, indications, contraindications, and management of potential complications. Learners will also explore the current literature, which is currently limited to case reports and observational data, highlighting the need for continued clinical evaluation and the development of best practices. The course emphasizes the essential role of an interprofessional team, including anesthesiologists, surgeons, nurses, and acute pain specialists, in optimizing catheter placement, monitoring for complications, and ensuring continuity of analgesia across perioperative settings. By participating in this activity, learners will enhance their procedural competence and interprofessional collaboration skills, ultimately improving patient outcomes through more effective pain management strategies. Objectives: Determine the clinical indications for the erector spinae plane block. Select the appropriate ultrasound-guided technique for safe erector spinae plane block placement. Evaluate the potential complications associated with erector spinae plane block. Apply interprofessional team strategies to improve care coordination and outcomes in patients undergoing an erector spinae plane block. Access free multiple choice questions on this topic.

The erector spinae plane block is a newer regional anesthesia technique that can be used to provide analgesia for various surgical procedures or to manage acute and chronic pain. First described in 2016 for thoracic neuropathic pain in patients with rib fractures and metastatic disease, the block has since gained rapid popularity due to its simplicity, safety profile, and versatility.[1] The technique is relatively easy to perform, even with minimal or no sedation, and is often initiated in the preoperative holding area. Erector spinae plane blocks can be administered as a single injection or via catheter placement for continuous infusion. Unlike other regional blocks limited to specific anatomical locations, the erector spinae plane block can be performed at multiple spinal levels and has been applied to surgeries ranging from thoracotomies and Nuss procedures to lumbar fusions and ventral hernia repairs.[2][3][4][5][6] As this is a relatively new procedure, the erector spinae plane block is still being tested in numerous trials with various types of surgical procedures, and several prospective studies are ongoing. This broad applicability contributed to its inclusion as one of the “Plan A” blocks endorsed by the Regional Anaesthesia UK. However, while strong evidence supports its efficacy in thoracoabdominal procedures, including reductions in opioid use and postoperative pain, results have been inconsistent in upper and lower limb surgeries. Furthermore, despite its widespread adoption, the precise mechanism of action remains incompletely understood, with variable sensory spread noted in clinical and imaging studies.[7] As a relatively novel technique, the erector spinae plane block continues to be investigated in prospective trials across various surgical domains to better define its efficacy, ideal indications, and limitations.

Complications are very rare because the site of injection is far from the pleura, major blood vessels, and the spinal cord. Infection at the needle insertion site, local anesthetic toxicity/allergy, vascular puncture, pleural puncture, pneumothorax, and failed block are the primary complications. Due to the limited published data, more investigations (eg, randomized controlled trials, RCTs) are needed to verify the safety, complication rates, and efficacy of this strategy.

Effective implementation of erector spinae plane blocks relies on the coordinated efforts of an interprofessional healthcare team. Anesthesiologists, anesthesiology residents, and nurse anesthetists typically perform the block in the preoperative holding area, requiring technical skill and familiarity with the procedure’s indications and safety protocols. Perioperative nurses support this process by assisting with patient positioning, conducting the pre-procedure timeout, and continuously monitoring the patient’s vital signs. Accurate verification of the procedure, laterality, and any patient-specific contraindications is essential. The use of sterile technique, along with the availability of resuscitation equipment, is critical to patient safety. Throughout the block, a nurse must remain attentive to the patient’s hemodynamic and respiratory status, ready to intervene should complications arise. Pharmacists also play a key role by preparing and verifying the appropriate anesthetic agents, ensuring proper dosing, and checking for potential drug interactions. Postoperatively, nurses are responsible for ongoing assessment and care, especially when erector spinae plane block catheters are used for continuous infusion. These catheters, which may resemble epidural lines, require clear labeling and staff education to prevent misidentification and ensure accurate administration. Nurses must be trained to recognize and respond to complications such as local anesthetic systemic toxicity, bleeding, or pneumothorax. Interprofessional communication among all team members—physicians, advanced practitioners, nurses, and pharmacists—is vital to ensuring safe, efficient, and patient-centered care. Through collaboration and shared responsibility, the healthcare team can enhance outcomes, reduce opioid use, and improve overall team performance and patient satisfaction.

Nurses play a vital role in preoperative preparation, block placement, and postoperative management of the catheter. Before placing the block, the nurse should participate in the timeout procedure, which includes verifying the procedure, the side of the procedure, patient allergies, and potential contraindications. During the actual procedure, the nurse should be monitoring the patient’s level of sedation and vital signs. The nurse can also help with patient positioning during the procedure. Post-operatively, the nurse will monitor the analgesia provided by the catheter, as well as watch for potential complications, including bleeding, local anesthetic toxicity, and pneumothorax.

The preoperative nurse will monitor the patient during the placement of the erector spinae plane block. Continuous ECG, pulse oximetry, and blood pressure (measured at least every 5 minutes) must be monitored throughout the entire periprocedural period. If sedation is used for the procedure, the preoperative nurse can also help monitor the patient's level of consciousness and breathing. Postoperatively, the post-anesthesia care unit nurse will continue to monitor the patient with continuous ECG, pulse oximetry, and blood pressure (at least every 5 minutes), and also track the patient's postoperative pain scores. If pain is severe, the anesthesiologist can bolus the catheter (if the catheter is placed) with the local anesthetic solution as needed, or the decision can be made to give intravenous medications to manage postoperative pain.