Top Tweets for #espblock
๐ฉป Looking Beyond Pain Scores
๐ Pilot RCT comparing ESP catheter, intravenous lidocaine infusion, and multimodal analgesia for rib fractures:
โ Similar pain scores
โ Similar opioid use
โ Less delirium with ESP
๐ https://t.co/Mpl9Jd8Dl3
#RegionalAnesthesia #ESPBlock #RAPM

๐ Debunking the ESP Block Myth: Itโs Not About the Bloodstream! ๐โ
โESP block works via systemic absorptionโ - Sounds clever, but letโs break it down with science and logic.
#ESPBlock #RegionalAnesthesia
#PainManagement #LocalAnesthetics #SpineSurgery
#TipOfTheDay #MyRATips
Tip of the Day:
๐ธ ๐ง Local Action, Not Global Confusion
๐ฏ Local anesthetics (LAs) block voltage-gated sodium channels at nerve membranes, halting nociceptive transmission.
This requires proximity to nerves, not floating around in the bloodstream.
๐ธ ๐งช Systemic Absorption โ Mechanism of Action
All LAs are absorbed systemically over time - itโs their natural metabolic fate.
๐ก But their analgesic effect is local, right where theyโre injected. No different for ESP.
๐ธ โก Systemic = Non-Selective = Toxicity
Sodium channels are everywhere: brain ๐ง , heart โค๏ธ, GI tract ๐.
โ ๏ธ Systemic LA canโt โchooseโ to act only on pain pathways - it may cause side effects, not targeted pain relief.
๐ธ ๐ ESP Block Mechanism: Fascial Magic
Injected deep to the erector spinae muscle, LA spreads in the interfascial plane.
๐งฌ It reaches dorsal rami, ventral rami, and sometimes even the paravertebral space โก๏ธ segmental analgesia from behind.
๐ The block is multi-dermatomal and longitudinally extensive, ideal for posterior thoraco-lumbar coverage.
๐ธ ๐ฏ Why It's Perfect for Spine Surgeries
Dorsal rami (DR) innervate:
Skin and muscles of the back
Facet joints
Posterior elements of the vertebrae
๐ช ESP block, by consistently involving DR, provides excellent posterior analgesia - making it highly useful in:
Lumbar decompressions
Posterior fusions
Laminectomies
Minimally invasive spine surgeries
๐ธ ๐งช The IV Lignocaine Fallacy
If systemic LA were truly effective for ESP-like analgesia, IV lignocaine would deliver the same effect.
โก๐ง It doesn't. Why? Because location matters. Proximity is power.
โ
Bottom Line
๐ ESP block works locally by targeting dorsal and ventral rami through interfacial spread - not systemically via bloodstream circulation.
๐ It's anatomically sound, clinically effective, and perfectly suited for back surgeries.
๐ Itโs not about the blood - itโs about the block.

๐ฅ๐ซ "Pain at the Core: On-Arrival Blocks for Chest and Abdomen" ๐งโโ๏ธ๐ก๏ธ
#PainAtTheCore #OnArrivalBlock
#TruncalAnalgesia #ChestWallBlock #AbdominalBlock
#RegionalAnesthesia #ESPBlock #TAPBlock
#SAPBlock #UltrasoundGuidedRA
#PointOfCareBlocks #OnArrivalRA #TipoftheDay #MyRATips
Tip of the Day:
๐ฆ Why FOCUS on Truncal Pain Early?
๐ซ Chest and abdominal injuries often compromise vital functions - especially breathing, coughing, and cooperation.
๐ฅ Pain in these regions is often deep, diffuse, and distressing, and opioids alone may not suffice or may cause respiratory depression.
๐ ๏ธ Regional blocks offer site-specific, opioid-sparing relief that improves immediate care and downstream outcomes.
๐จ CLINICAL GOALS of Truncal On-Arrival Blocks
๐ซ Restore respiratory efficiency (chest trauma, rib fractures)
๐ Facilitate imaging, positioning, and transport
๐ง Relax abdominal guarding (peritonitis, pancreatitis)
๐ Reduce sympathetic overdrive in trauma
๐ซฑ Enhance cooperation for procedures or airway planning
๐ซ COMMON INDICATIONS
๐ฆ Chest Wall:
Rib fractures (especially multiple)
Flail chest
Post-thoracostomy or chest tube placement
Chest wall contusions in blunt trauma
๐จ Upper Abdomen:
Blunt abdominal trauma
Acute pancreatitis
Upper GI perforation or distension
Postoperative laparotomy or laparoscopy pain
๐ง Lower Abdomen:
Inguinal hernia (painful or strangulated)
Appendicitis with guarding
Abdominal wall hematomas or incisional pain
๐ช BEST CHOICES
๐ซ For Chest Wall Injuries:
ESPB, SAPB, or ICNB.
Provide broad dermatomal coverage.
Safe to perform away from critical structures like the pleura.
Ideal for rib fractures, flail chest, and chest tube insertion pain.
๐งผ For Upper Abdominal Pain:
ESPB at T6โT9 levels or TAP Block.
Relieve guarding and improve respiratory effort in conditions like pancreatitis or blunt abdominal trauma.
๐งฉ For Lower Abdominal Conditions:
TAP Block, RSB, IIN/IHN Block.
Provide localized anterior abdominal wall analgesia. Suitable for inguinal hernia, appendicitis, or post-incisional pain.
๐ฅ ESPB: CHAMPION?
โ
Superficial and safe (away from pleura/major vessels)
โ
Wide craniocaudal spread
โ
Suitable for non-sterile or semi-sterile environments
โ
Excellent for rib fractures and abdominal wall pain
โ
Can be done quickly with or without USG
๐ง KEY PEARLS
๐งผ Basic aseptic precautions suffice in emergency use
๐ฉป USG is ideal but can be landmark-based if skilled
๐งพ Document block site, volume, drug, and response
โฑ๏ธ Reassess for conversion to longer-acting block or catheter if needed
๐ซ CHEST WALL BLOCKS: RULE
โHit the Rib, Deposit the Drugโ
๐นDeep SAP Block โ Needle hits the rib, inject deep to serratus
๐นExternal Oblique Intercostal Plane Block โ Target rib at anterior/mid-axillary line, inject above EO
๐นParasternal Block โ Identify rib near sternum, inject in intercostal plane
๐ฏA safe, reproducible approach - perfect for emergency or limited-resource settings.
๐จ ABDOMINAL WALL BLOCKS: RULE
โFollow the Muscle, Find the Planeโ
๐นTAP Block โ Feel or visualize the abdominal wall โ insert between internal oblique & transversus abdominis
๐นRectus Sheath Block โ Palpate the rectus muscle โ inject posterior to it, above posterior sheath
๐นIlioinguinal/Iliohypogastric Block โ Palpate ASIS โ inject in plane between internal oblique and transversus abdominis near the iliac crest
๐ฏKey Tip: Identify the muscle โ follow its plane โ deposit where spread flows freely.
โ
Reliable, reproducible, and effective for anterior abdominal wall analgesia.
"When pain impairs breathing or masks diagnosis, a timely On-Arrival Block for the trunk may be your best intervention - not just for comfort, but for survival."

Apologies- it seems the audio didnโt upload!
Here is a new link!
@ANZRA_X
#RegionalAnaesthesia #RegionalAnesthesia #ESPblock
https://t.co/TiKcHzlrwD
Iโve posted a quick update to my ESP talk based on my @ANZRA_X talk this year and including some useful insights from @KiJinnChin & Mauricio Forero
Check it out here:
https://t.co/89WP0keJkJ
#RegionalAnaesthesia #RegionalAnesthesia
I like to have patients lateral for an ESP if possible as they don't need anyone to help them to stay in position, and they often drift off once the local starts to work. This doesn't work if fractures are very near the transverse process. #rauk25 #rauk #espblock @amit_pawa
"Donโt Be Fooled: Why ESP Block Isnโt a Spine Surgery Soloist"
#ESPBlock #AnesthesiaTips #SpineSurgery #RegionalAnesthesia #PainManagement #PatientSafety #MinimallyInvasive
#MyRATips
Tip of the day
The Erector Spinae Plane (ESP) Block may look like a magic trickโbut here's why it's not your one-stop solution for spine surgeries:
๐ฏ Targets dorsal rami only consistently โ covers skin & deep muscles
๐ซ Misses anterior rami โ which supply superficial/intermediate muscles & thoracolumbar fascia
โ ๏ธ Medial branch spread? โ too unpredictable to trust
๐ฅ Fascial pain generators โ often go untouched
๐ Airway security in prone โ GA is a must for patient safety, isn't it?
So, when does ESPB shine?
โ
Great for minimally invasive procedures (e.g., vertebroplasty, endoscopic discectomy)
โ Not enough for open or major spine surgeries
Use ESPB smartlyโbut donโt fly solo when the stakes are high!

If you only can learn one truncal analgesia block then I would recommend this. It is easy, generally safe, effective, and can be done anywhere from cervical to sacral spine.
Learn more: https://t.co/cvnBXO6qWT
#ESPblock #RegionalAnalgesia #chronicpain #acutepain #painphysician

" THORACIC WALL BLOCKS:
An Art of Looking Between the Lines"
#Thoracicwallblocks
#Chestwallblocks
#Parasternalblocks
#PECSblocks
#SAPblocks #PVB #ESPblock #RISSblock #ITPblock
My 10 points between 6 LINES:
ANTERIOR CHEST WALL BLOCKS:
(A) Medial to the Midclavicular line:
PMM covers ribs & ICMs in the parasternal region. External ICM becomes the Anterior Intercostal Membrane anteriorly (Posterior Intercostal Membrane is formed by Internal ICM posteriorly).
1. Parasternal blocks: Probe placed sagitally over the parasternal region. LA deposition- Between PMM and ICM for Superficial parasternal block OR between internal ICM and transversus thoracic muscle for Deep parasternal (Transversus Thoracic Plane) block. Coverage- Anterior cutaneous nerve T2-T6. Vascular landmark- Internal mammary A. in TTP block.
(B) Between Midclavicular - Anterior axillary lines:
Muscles from superficial to deep include PMM, PMnM, and SAM above ribs & ICMs.
2. PEC ZERO (Modified Clavipectoral Fascial Plane) block:* Probe placed vertically between the clavicle (proximally) and 2nd Rib (distally). LA deposition- Above and below PMnM. Vascular landmark- Acromial branch of TAA.
3. PEC 1 (InterPectoral plane) block: Probe over 2nd Rib. LA deposition- Between PMM and PMnM. Vascular landmark- Pectoral branch of TAA. Coverage- LPN & MPN.
4. PEC 2 (Pecto-Serattus Plane) Block: Probe over 3rd Rib. LA depostion (2 injections)- Between PMM-PMnM & PMnM-SAM. Coverage- LPN & MPN, ICNs T2-T6.
(C) Between Anterior - Posterior Axillary lines:
Muscles include SAM (anterior to midaxillary line). LDM & SAM (posterior to midaxillary line) above the ribs.
5. BRILMA (on 4/5th ribs) and modified BRILMA (on 7/8th ribs): Probe placed at midaxillary. LA depostion- Between SAM and Ribs. Coverage- Lateral cutaneous nerves T2-T7 (BRILMA) and T5-T12 (modified BRILMA).
6. SAP 1 (superficial SAP): Probe between Midaxillary- Posterior axillary lines. LA deposition- Between SAP muscle and LDM at 4/5 th ribs level. Coverage-Intercostobrachial N., T3-T9, LTN, and TDN.
SAP 2 (Deep SAP): LA deposition below SAM at 4/5 th ribs level. Vascular landmark- Thoracodoral A above SAM. Coverage- Intercostobrachial N. and T3-T9.
POSTERIOR CHEST WALL BLOCKS:
(D) Probe kept parasagittal 2.5 cm lateral to the midline:
7. Thoracic PVB: LA deposition above pleura by piercing superior costotransverse ligament.
8. Inter Transverse Process (ITP) Block: LA deposition anterior to C-T ligament in the retro CT space.
(E) Probe kept parasagittal 4 cm lateral to the midline:
9. Thoracic ESP Block: LA deposition below ESPM by hitting the tip of the TP.
(F) Probe between TP and Scapula:
10. RISS (Rhomboids Intercostal Sub-Serratus plane) Block: LA deposition between RHM-ICM along the Medial border and below SAM at the inferior angle of the Scapula. Coverage- T2-T11 dermatomes.

A balanced discussion of #ESPblock??
Is it possible? Maybe...
๐๐https://t.co/fbCRtPK9fT
@Ropivacaine @DalAnesthesia @CJA_Journal
Currently, there are four proposed mechanisms of action of the ESP block:

@GongGasGirl @rosie_hogg @jeffgadsden What Wut?
#ESPBlock covers what?! ๐๐
@jeffgadsden @BlockIt_Hot_Pod #AC2023
#SAP block and #ESPblock for thoracotomy. #RCT in Feb 2022 issue.
Read here: https://t.co/0lBbcY6nEy
@AoraIndia @ESRA_Society @RegionalAnaesUK @CJA_Journal @AFSRA10 @aosra_pm

A pilot RCT comparing ESP block and Thoracic Epidural for traumatic rib fractures in July 2023 issue of #IJA
Read here: https://t.co/aq1TiyaQKt
@STS_CTsurgery @NM_Lung @ThoracicAGuys @CritCareReviews @SOCCA_CritCare @UCL_RCCA @WOSCCT @CCRG_Research #espblock #thoracicepidural

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiCkSah

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiCkSah

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiCkSah

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiCkSah

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiCkSah

Its a good day in ED when my patient says that his chest pain is completely gone after my #ESPblock.
Regional anaesthesia is a must have skill for ED physicians
Conversation: Phenol spread in erector spinae plane block for cancer
Article: https://t.co/k98YUPTkZ2
Letter: https://t.co/b6zjABpIqF
Letter: https://t.co/NDPYRTgCwL
#regionalanesthesia #pain #ESPblock
@gdossantos_md @AndresR00916584 @dr_rajgupta @ESchwenkMD @ASRA_Society

Check out the new BJA #miniflipbook with all of the FREE content from the May issue.
Articles on: #ESPblock #hypotension #cognitivedysfunction #sepsis #paediatrics #EEG #cancerpain #fatigue #FONA
https://t.co/5l2QiClpZP

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