Mechanism of the erector spinae plane block: insights from a magnetic resonance imaging study

  • Ana Schwartzmann
  • Philip Peng
  • Mariano Antunez Maciel
  • Mauricio ForeroEmail author

To the Editor,

The erector spinae plane block (ESPB) has emerged as a valuable regional anesthesia technique for a range of thoracic, abdominal, and other procedures. Early cadaveric injection and computerized tomographic scan imaging studies1,2 have suggested that the local anesthetic spreads in a cephalocaudal direction within the fascial plane, deep to the erector spinae muscle in the paraspinal region and potentially spreads towards the paravertebral space through the inter-transverse soft tissue.3 How the anesthetic spreads to achieve somatic and visceral blockade is largely unclear.

We present magnetic resonance imaging (MRI) that provides additional anatomical information on the potential mechanism of the ESPB. A 38-yr-old female (who consented to this report) with post-surgical chronic visceral abdominal pain received an ultrasound-guided ESPB, which rendered her pain free. Four months later, the patient was still pain free but gave written consent to have an investigative...


Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Funding received



  1. 1.
    Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-7.CrossRefPubMedGoogle Scholar
  2. 2.
    Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anesth 2018; 65: 288-93.CrossRefPubMedGoogle Scholar
  3. 3.
    Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017; 72: 452-60.CrossRefPubMedGoogle Scholar
  4. 4.
    Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; 68: 1107-13.CrossRefPubMedGoogle Scholar
  5. 5.
    Blanco R, Fajardo M, Parras Maldonado T. Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery. Rev Esp Anesthesiol Reanim 2012; 59: 470-5.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Ana Schwartzmann
    • 1
  • Philip Peng
    • 2
  • Mariano Antunez Maciel
    • 3
  • Mauricio Forero
    • 4
    Email author
  1. 1.Department of Anesthesia, Hospital de ClinicasUniversidad de la RepublicaMontevideoUruguay
  2. 2.Department of Anesthesia and Pain ManagementUniversity of TorontoTorontoCanada
  3. 3.Department of AnesthesiaAsociacion EspañolaMontevideoUruguay
  4. 4.Department of AnesthesiaMcMaster UniversityHamiltonCanada

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