The Analgesic Mechanism and Recent Clinical Application of Erector Spinae Plane Block: A Narrative Review

Jing Han Yang,1,* Ye Sun,1,* Yi Ran Yang,1 Ling Na Qi,1 Wan Yao Li,1 Xiang Zheng Qin2 1School of Medicine, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China; 2Department of Human Histology and Anatomy, Yanbian University, Yanji City, Jilin Province, 136200, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Zheng Qin, Department of Human Histology and Anatomy, Yanbian University, Park Street, Yanji City, Jilin Province, 136200, People’s Republic of China, Email [email protected]: Now, the erector spinae plane block (ESPB) is widely used in various thoracolumbar surgeries. It has unique advantages: simple and convenient operation, low safety risks, and reduced opioid use. The ESPB is used in thoracic surgery, abdominal surgery, and spinal surgery. There are also relevant research reports on postoperative analgesia during general anesthesia surgery. This article searches the PubMed and Web of Science databases to find and screen relevant studies on ESPB since 2019 and retrospectively summarizes the current indications of ESPB. The methodological quality of the included studies was assessed using the Cochrane bias risk tool. The results showed that the current research on ESPB generally provides low-level clinical evidence. The complex anatomy of the erector spinae muscles is both responsible for its unique advantages and restricts its development. Few anatomical studies have clearly and completely demonstrated the diffusion relationship of local anesthetics among the anatomical structures of the erector spinal muscles. The uncontrollability of the diffusion plane prevents ESPB from being applied on a wider scale with a high level of evidence. To further clarify the scope of application of ESPB and achieve the best analgesic effect, in the future, we should focus on the unique anatomical course and distribution of the erector spinal muscles and their fascia and nerves. It is necessary to combine anatomical, imaging, and histological methods to obtain high-quality evidence to guide clinical application.Keywords: erector spinae plane block, fascial plane block, anatomy, regional anesthesia, pain, nerve block