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BC Point of Care Ultrasound

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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: Local Anesthetic Systemic Toxicity)

Where you put the probe and needle:

• Position - sitting, prone or lateral decubitus
• Linear high frequency probe
• Use sterile/semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

aimg ESB probe place-min
SP (JPG)

• Start by finding the spinous process midline

SP2

 

Identify the transverse process:

• The transverse process is ~3cm lateral to the spinous process and is ~2-3cm deep

ESB-lat - compressed (2)
ESB-2

• View the spinous process midline then slide lateral to lamina, and then transverse process (transverse process will be more superficial to lamina)

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 visualize the needle tip

ESB-Block (2)

• Injecting anesthetic deep to the erector spinae muscle/plane

Where you put the probe and needle:

• Position - sitting, prone or lateral decubitus
• Linear high frequency probe
• Use sterile/semi-sterile technique
• Place in longitudinal plane
• Probe marker to patient’s head

ESB probe place2

• Start by finding the spinous process midline

SP (JPG)
SP2

 

Identify the transverse process:

• The transverse process is ~3cm lateral to the spinous process and is ~2-3cm deep

ESB-lat - compressed (2)

• View the spinous process midline then slide lateral to lamina, and then transverse process (transverse process will be more superficial to lamina)

ESB-2

• The more rounded rib is lateral of the transverse process
• Avoid the lungs (may see lung sliding lateral and deep)

ESB-1 (3)

 

Inject the anesthetic:

• Insert needle from above or below using in plane technique

• Always visualize the needle tip

ESB Graphic 2.2 (JPG)

• Injecting anesthetic deep to the erector spinae muscle/plane

ESB-Block (2)