Treatment of thoracic posterior cutaneous nerve entrapment syndrome using an ultrasound-guided erector spinae plane block

Posterior cutaneous nerve entrapment syndrome (POCNES) is a rare and often overlooked cause of chronic paravertebral back pain. Treatment options for POCNES are not well established. Herein, we describe a teenage patient with a 3-month history of left parascapular pain and dysaesthesia unresponsive to analgesics or physiotherapy. Physical examination revealed a hyperalgesic and hypoaesthetic area lateral to the eighth thoracic vertebra. Imaging and laboratory tests showed no significant findings. A trigger-point injection provided temporary pain relief, which aided in diagnosing POCNES, although the relief was short-lived. We then performed an ultrasound-guided erector spinae plane (ESP) block, which effectively resolved the patient's pain without recurrence. Diagnosing POCNES requires a high level of suspicion, thorough history-taking and focused physical examination to identify its neuropathic features. The ultrasound-guided ESP block may be a treatment option for managing POCNES.