BCPoCUS - BC Point of Care Ultrasound

BC Point of Care Ultrasound

Your go-to resource for point-of-care ultrasound rapid summaries and videos.

Erector Spinae Plane Block

Rapid Summary

When to block:

Patients presenting with:
• Rib fractures (3 or more)
• May consider in burns, shingles, transverse process fractures, chest tubes

Amount of anesthetic:

• ~15-20cc 0.5% bupivacaine
• Bupivacaine max dose: 2-2.5mg/kg (175mg/dose)
• Monitor patient on cardiac monitor for at least 60min (re LAST)

Where you put the probe and needle:

ORGANIZATION 1

aimg ESB probe place-min

• Position - sitting, prone or lateral decubitus
• Linear High Fq probe
• Use Sterile/Semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

SP jpeg
SP (JPG)

• Start by finding the Spinous Process midline

Identify the Transverse Process:

ESB-lat - compressed (2)

• The Transverse Process is ~3cm lateral to the Spinous Process

ESB-2

• View the Spinous Process midline then slide lateral to Lamina, and then Transverse Process (Transverse Process will be more superficial to Lamina and with a flatter top than more rounded Ribs)

ESB-1 (3)

• The more rounded Rib is lateral of the Transverse Process
• Avoid the lungs (may see lung sliding lateral and deep)

Inject the anesthetic:

ESB Graphic 2.2 (JPG)

• Insert needle from above or below using in plane technique, always visualizing the needle tip

ESB-Block (2)

• Injecting anesthetic deep to the Erector Spinae muscle/plane

ORGANIZATION 2

aimg ESB probe place-min

• Position - sitting, prone or lateral decubitus
• Linear High Fq probe
• Use Sterile/Semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

SP jpeg
SP (JPG)

• Start by finding the Spinous Process midline

ESB-lat - compressed (2)

• The Transverse Process is ~3cm lateral to the Spinous Process

ESB-2

Identify the Transverse Process:
• View the Spinous Process midline then slide lateral to Lamina, and then Transverse Process (Transverse Process will be more superficial to Lamina and with a flatter top than more rounded Ribs)

ESB-1 (3)

• The more rounded Rib is lateral of the Transverse Process
• Avoid the lungs (may see lung sliding lateral and deep)

ESB Graphic 2.2 (JPG)

• Insert needle from above or below using in plane technique, always visualizing the needle tip

ESB-Block (2)

• Injecting anesthetic deep to the Erector Spinae muscle/plane

ORGANIZATION 3

aimg ESB probe place-min

• Position - sitting, prone or lateral decubitus
• Linear High Fq probe
• Use Sterile/Semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

SP2
SP (JPG)

• Start by finding the Spinous Process midline

Identify the Transverse Process:

ESB-lat - compressed (2)

• The Transverse Process is ~3cm lateral to the Spinous Process

ESB-2

• View the Spinous Process midline then slide lateral to Lamina, and then Transverse Process (Transverse Process will be more superficial to Lamina and with a flatter top than more rounded Ribs)

ESB-1 (3)

• The more rounded Rib is lateral of the Transverse Process
• Avoid the lungs (may see lung sliding lateral and deep)

Inject the anesthetic:

ESB Graphic 2.2 (JPG)

• Insert needle from above or below using in plane technique, always visualizing the needle tip

ESB-Block (2)

• Injecting anesthetic deep to the Erector Spinae muscle/plane

ORGANIZATION 4

aimg ESB probe place-min

• Position - sitting, prone or lateral decubitus
• Linear High Fq probe
• Use Sterile/Semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

SP jpeg
SP (JPG)

• Start by finding the Spinous Process midline

 

Identify the Transverse Process:

ESB-lat - compressed (2)

• The Transverse Process is ~3cm lateral to the Spinous Process

ESB-2

• View the Spinous Process midline then slide lateral to Lamina, and then Transverse Process (Transverse Process will be more superficial to Lamina and with a flatter top than more rounded Ribs)

ESB-1 (3)

• The more rounded Rib is lateral of the Transverse Process
• Avoid the lungs (may see lung sliding lateral and deep)

 

Inject the anesthetic:

ESB Graphic 2.2 (JPG)

• Insert needle from above or below using in plane technique, always visualizing the needle tip

ESB-Block (2)

• Injecting anesthetic deep to the Erector Spinae muscle/plane

Where you put the probe and needle:

ulnar nerve block
  • Identify ulnar artery near wrist, ulnar nerve lies on ulnar aspect of artery!
  • Helps to have shoulder abducted and external rotated as shown
  • Slide proximal to find easiest access to nerve for in-plane injection
ulnar
  • Injecting anesthetic alongside ulnar nerve