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Lucente, Ragonesi, Sanguigni, Sbaraglia, Vergari, Lamacchia, Del Prete, and Rossi: Erector spinae plane block in children: a narrative review
Review Article

Korean J Anesthesiol 2022;75(6):473-486.

Published online: 5 July 2022

DOI: https://doi.org/10.4097/kja.22279

Erector spinae plane block in children: a narrative review

Monica Lucente, Giulia Ragonesi, Marco Sanguigni, Fabio Sbaraglia, Alessandro Vergari, Rosa Lamacchia, Demetrio Del Prete, Marco Rossi

Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

Corresponding author: Fabio Sbaraglia, Ph.D. Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy Tel: +39-3497730144 Fax: +39-0630151 Email: fabio.sbaraglia@policlinicogemelli.it

Received 7 May 2022       Revised 4 July 2022       Accepted 4 July 2022

Copyright © The Korean Society of Anesthesiologists, 2022

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The erector spinae plane block (ESPB) is a novel technique used in both adult and pediatric patients. Its use in children has mostly been described in terms of perioperative pain management for various types of surgery. After its introduction, anesthesiologists began using ESPBs in various surgical settings. As adequate analgesia along with a low complication rate were reported, interest in this technique dramatically increased. Many studies in adults and children, including randomized controlled trials, have been published, resulting in the emergence of different clinical indications, with various technical and pharmacological approaches currently evident in the literature. This narrative review aims to analyze the current evidence in order to guide practitioners towards a more homogeneous approach to ESPBs in children, with a major focus on clinical applications. The ESPB is an efficient, safe, and relatively easy technique to administer. It can be applied in a wide range of surgeries, includes thoracic, abdominal, hip, and femur surgery. Its usefulness is evident in the context of enhanced recovery after surgery protocols and multimodal analgesia. Single-shot, intermittent bolus, and continuous infusion techniques have been described, and non-inferiority has been observed when compared with other locoregional techniques. Even though both the efficacy and safety of the procedure are widely accepted, current evidence is predominantly based on case reports, with very few well-designed observational studies. Consequently, the level of evidence is still poor, and more well-designed double-blind, randomized, placebo-controlled trials are needed to refine the procedure for different clinical applications in the pediatric population.

Keywords: Analgesia, Anesthesia, Child, Conduction anesthesia, Nerve block, Newborn infant, Review

Introduction

The erector spinae plane block (ESPB), which was first described by Forero in 2016 [1] for the treatment of thoracic neuropathic pain, was applied in the pediatric population for postoperative pain management as early as 2017 [2]. Subsequent interest in this technique has rapidly expanded and expertise has increased, with applications not only for the management of perioperative analgesia but also for non-surgical pain management in the pediatric population (Table 1).
Despite more extensive series and observational evidence in the current literature, very few rigorous, well-designed trials have been conducted (Table 2). While these include a few randomized controlled studies, the protocols and indications used have been highly variable. The efficacy and safety of ESPBs in perioperative pain management have been explored in many case reports and observational studies compared with other loco-regional procedures (Tables 1 and 2). However, the position, timing, and pharmacological approach are highly variable across operators and no standardized protocols are available.
The level of evidence is still limited, and a general consensus on these aspects is lacking. The purpose of this narrative review is therefore to provide an overview of the state of ESPBs in children, highlighting critical aspects and future perspectives to guide practitioners towards a more homogeneous approach.

Clinical indications

ESPBs have been proposed for a wide variety of potential applications, especially as part of a multimodal perioperative analgesia regimen to promote enhanced recovery after surgery (ERAS) in numerous kinds of procedures, ranging from chest and abdominal to inguinal and lower limb surgeries. In fact, analgesia can be attained in a broad range of anatomical areas depending on the vertebral level of local anesthetic (LA) injection, with extensive craniocaudal spread providing anesthesia coverage to multiple dermatomes [3]. Consequently, this technique allows for the operator to achieve analgesia in the desired region with an injection that is remote from the surgical incision area [2].
While ESPBs could be synergistic with other locoregional techniques, to date, it has mostly been reported as an alternative to other approaches. For example, the ESPB has been used as an alternative to the thoracic epidural, a classic technique for cardiothoracic surgeries involving a midline sternotomy or thoracotomy, as it is considered safer because it is injected farther from important structures, such as the spinal cord, pleura, and vascular structures [4]. Bilateral ESPBs at the T3-T4 level have been shown to provide improved postoperative analgesia compared to no block in children undergoing cardiac surgeries involving a midline sternotomy [5,6].
Several reports have described the use of ESPBs for perioperative pain management during lower body surgeries. The non-inferiority of the ESPB to the quadratus lumborum block in pediatric lower abdominal surgeries has been shown [7]. Bilateral ESPBs can provide superior intraoperative and postoperative analgesia compared to sham blocks for splenectomies involving a midline incision [8] and compared to no block for lower abdominal surgeries [9]. ESPBs have also been shown to provide more effective and longer-lasting postoperative analgesia than ilioinguinal/iliohypogastric blocks in unilateral inguinal hernia repairs [10].
Despite the fact that caudal epidurals are one of the most extensively used regional blocks in children undergoing hip and lower abdominal surgeries [11,12], no studies have compared caudal epidurals to ESPBs in pediatric patients. Additionally, no comparisons between ESPBs and psoas compartment blocks in hip surgery have been conducted, even though the effectiveness of both techniques have been confirmed [13–16].
A reduction in the use of intraoperative and postoperative analgesics for opioid-sparing general anesthesia has also been demonstrated with ESPBs [5,6,8]. Anecdotal evidence in the form of case studies and small case series have been reported for numerous applications of the ESPB as part of a multimodal opioid-sparing analgesia regimen, including for thoracotomy, thoracoscopic surgery, thoracic wall surgery [2,3,4,18–27], sternotomy [28], abdominal surgery [29–37] spinal surgery [38], genital surgery [39] and hip joint and proximal femur surgery [14–16,40].
Outside the operating room, ESPBs have been successfully employed for pain control in pediatric oncological palliative care [41].
Beyond the use of ESPBs as a routine technique in the pediatric anesthesiologist’s arsenal, it has also been applied in the management of particularly complex cases. Due to the craniocaudal spread of ESPBs, it can be injected at a remote point from the vertebral level of the incision site [42], and thus may be used when there is an incision site infection or as a valid alternative to neuraxial anesthesia in the case of spinal deformities, previous spinal surgery, or neuraxial spread of neoplastic disease [43–45]. ESPB catheters have also been used successfully when epidural and paravertebral catheters are not possible due to coagulopathy [46]. The high safety profile of the ESPB in terms of the hemodynamic impact has led to its consideration by clinicians who are reluctant to use epidural anesthesia in patients with heart defects [47]. Additionally, during the perioperative period of an emergency laparotomy, analgesia has been provided by ESPBs even in very low birth weight premature infants, despite their small size [48].

Anatomy, technique, and diffusion of the anesthetic solution

Accurate knowledge of pediatric anatomy is essential for performing an ESPB and achieving an adequate sensory blockade. Anatomical differences between adult and pediatric patients, such as the muscles, fascia, and connective tissues under the skin, which are usually thinner and less rigid in pediatric patients, must be taken into account. Therefore, neonatal/pediatric probe, shorter needle, and lower drug volume should be considered.
Regardless of the vertebral level, the target of this fascial plane block is the erector spinae fasciae plane. This is a virtual space located under the erector spinae muscles that communicates with the paravertebral space where the dorsal rami of the spinal cord is located (Fig. 1).
The erector spinae muscles constitute the intermediate layer of the deep muscles of the vertebral column, arising from the posterior part of the iliac crest, sacrum, and lumbar spinous processes. It encompasses the spinalis, longissimus dorsi, and iliocostalis muscles. These muscles are located posterolaterally to the vertebral column, lying between the vertebral spinous processes medially and angles of the ribs laterally.
During sonography, the probe should initially be placed at the midline of the spine with a transverse orientation to visualize the spinous processes. Moving laterally, the transverse processes can then be located. Maintaining the probe in a transverse orientation, an out-of-plane approach can be used, with the needle placed in a craniocaudal or caudocranial direction. Otherwise, after a 90° rotation of the probe, an in-plane approach is also possible.
The structures are visualized from superficial to deep as follows: the trapezius, rhomboid, and erector spinae muscles and the transverse process of the respective vertebra.
The needle must be advanced to the tip of the transverse process, after which the LA can be injected to hydrodissect the plane deep to the erector spinae muscle to verify the proper injectate location before injecting the residual volume. Alternatively, if the patient’s weight allows for only very small volumes of LA, normal saline may be used for this initial hydrodissection to spare the LA allowance.
The distance between the skin and tip of the transverse process is very small in pediatric patients and can vary considerably according to age and body mass index. Therefore, small-sized needle devices and a stable position are required to perform the block.
The above mentioned approach, which is mostly conducted in the prone position in children, is similar to that used in the first reports of ESPBs conducted on two adult patients in the sitting position [1]. As this technique has been increasingly applied in the pediatric population and refined for the particular needs of these patients, several other approaches have been developed. In 2018, an ESPB administered with the patient in the lateral decubitus position was described by placing the ultrasound probe transversely to obtain a midline view of the spinous and transverse processes of the vertebral and erector spinae muscles, using an out-of-plane technique [49].
The Aksu approach for lumbar ESPBs has also been described in pediatric patients, in which an in-plane technique in the lateral decubitus position is applied, thus eliminating the need to turn the anesthetized patient prone and then back to a supine position for surgery [50]. The major disadvantage of this approach is the inability to visualize the craniocaudal spread of the LA, which is only possible when the probe is turned to the sagittal position after the block is performed [51].
Regardless of the technical approach, LAs injected into the erector spinae fascial plane are meant to spread through the paravertebral space, not only at the level of the injection site but also cranially and caudally to reach distant dermatomes. However, the exact diffusion pathway remains controversial. The dorsal rami emerges from the paravertebral space and moves through the inter-transverse connective tissue complex. The ventral rami continues from the paravertebral to the intercostal space, becoming the intercostal nerves. The involvement of the ventral rami is contested since no solid evidence is available on the actual route of spread of the injected drugs.
Different methods have been adopted to study the spread of LAs; however, most are described in adult patients whose tissues are much more rigid and stiffer than those of children. Sonography, while clearly a limited technique, is useful for studying the cephalocaudal distribution of the injectate and is feasible in the pediatric population. Munoz et al. [2] observed the spread of LA from T5 to T11 after an 8-ml injection of solution was performed at T8 in a 7-year-old patient. Additionally, the distribution of a 3.2-ml solution from T1 to T9 was documented via ultrasound in a 3-year-old patient after an ESPB was performed at T1 [17]. In another case report, the same author visualized the spread of 1 ml of solution between T4 and L1 following an ESPB performed at T6 in a 2-month-old infant [52]. A wide distribution was also observed between L1 and L4 following the administration of 4.5 ml of solution at L2 in a 4-year-old patient [53].
A cadaveric study that analyzed the spread of a methylene blue dye solution in two embalmed preterm stillborn neonates weighing 1.6 and 0.6 kg was also conducted. The first cadaver received a unilateral 0.5-ml injection of solution at the T5 level, and superficial cephalocaudal diffusion from T2 to T12 was observed, with deeper staining of the ventral and dorsal roots and ganglia between T3 and T6. In the second cadaver, in which a 0.2-ml injection was performed at the T8 level, superficial staining spread from T7 to L1 and dorsal and ventral roots/ganglions were involved from T7 to T11. In both cases, the paravertebral and epidural spaces as well as the dura mater surrounding the spinal cord were stained [54].
CT scanning with multi-slice and three-dimensional (3D) technology has been used to assess the spread of iodinated contrast dye in a fresh unembalmed preterm neonatal cadaver weighing 2.7 kg. The first injection (2.3 ml) was performed at the T8 level on the right side and a second injection (2.3 ml) on the opposite side was performed at the T10 level. 3D reconstruction revealed diffusion of the dye from T6 to T9 on the right side and from T9 to T11/T12 on the left side. Contrast dye was seen in the paravertebral space but not in the epidural space, spreading over the costotransverse ligament and reaching the intercostal space. The lack of spread to the epidural space could be explained by in vivo factors, such as intrathoracic pressure changes and the absence of muscle tone and tissue tension. The study suggested a volume of 0.3–0.4 ml per dermatome, with involvement of 3 to 4 dermatomes with the ESPB [55].
The paucity of data available regarding injectate spread in children requires that adult studies be referenced. However, considerable differences in diffusion patterns in adult and pediatric patients must be recognized in relation to multiple factors, such as the developmental formation of the vertebral curvature, more elastic pediatric spine, and less dense ligaments and cartilaginous laminae [54]. Drug distribution in the adult population has been observed in MRI and cadaveric studies, which suggest different possibilities for lateral and anterior diffusion of LAs. Beyond anatomy, the vertebral level [56] and drug volume [57] are also relevant factors in the spread of injected LA. Analyses of cadaveric samples have revealed anterior and posterior diffusion of the injectate with different percentages at different vertebral levels, with inconclusive results. Paravertebral, intercostal, and epidural spread have been described, but these findings are not consistent among the available studies [56–68]. Given these variabilities in adult MRI and cadaveric studies, the results are inconclusive and presumably related to the site of injection, volume of solution, and physical characteristics of the tissues.
Although this technique is clearly effective, given its many successful clinical applications, evidence regarding the precise diffusion of the injected solution in children is not entirely clear, with only two studies on neonatal cadavers [54,55] and several case series reporting data from in vivo sonographic imaging.

Choice and dosage of local anesthetics

The pharmacological approaches described in the current literature are highly inconsistent, as the procedure has multiple applications and the specific pharmacological approach associated with the variety of clinical contexts is variable.
Bupivacaine, ropivacaine, and levobupivacaine at different concentrations and volumes have been most commonly used for ESPBs in pediatric patients, with no significant differences in postoperative pain management between them.
In the first documented application of the ESPB in children in the literature, a single shot injection of 14 ml of 0.5% bupivacaine performed at T8 was administered to a 7-year-old boy undergoing surgery for the treatment of a tumor of the eleventh rib [2].
Most of the pediatric ESPBs currently described in the literature are performed with 0.25% bupivacaine, with volumes ranging from 0.3 to 0.6 ml/kg [19,20,25,30,31,33,36,69,70].
A 1 : 1 solution of 0.25% bupivacaine and 1% lidocaine with a total volume of 0.2 ml/kg was administered via ESPB as a single shot injection to a 3-year-old girl weighing 16 kg undergoing surgical resection of dorsal lipoma. The patient was discharged 4 h after surgery with full pain control [17]. The same solution at a dosage of 0.4 ml/kg was administered as a single shot ESPB in a 2-month-old infant before inguinal hernia repair [53].
The use of levobupivacaine 0.2% (4 ml) for thoracic surgery in a 5-month-old female was also reported [71] to enhance recovery after surgery.
The first continuous ESPB in the literature was administered to a 3-year-old boy, who received an 8-ml initial injection of 0.25% levobupivacaine through a catheter placed at the T9 level at the end of a thoracotomy. Two hours later, a patient-controlled analgesia pump with 0.1% levobupivacaine (3 ml/h continuous infusion) was started, with a standing order of 1.5-ml rescue boluses at 30-min lockout intervals. On the fourth postoperative day, the infusion was stopped. Only two 1.5-ml rescue boluses were administered and no other medications were required to control pain [47].
A 7-month-old infant received 0.2% ropivacaine through a catheter placed at the T6 level (1 ml/h) prior to an upper lobectomy for a congenital pulmonary airway malformation. The catheter was removed on the third postoperative day, and pain scores showed adequate analgesia [72].
A retrospective review of a single center on various surgeries described the efficacy of ESPBs with 0.5% ropivacaine in children, with an initial loading dose of 0.4 ml/kg followed by intermittent boluses of 0.2%–0.3% at 0.3 ml/kg administered hourly [73].
Pharmacokinetic variability must be taken into account for all fascial plane blocks. In contrast to peripheral nerve blocks, where anesthetics are precisely deposited around a specific nerve, a consistent level of intensity of the sensory blockade cannot be expected for fascial plane blocks. Moreover, differences in tissue laxity in pediatric patients could contribute to increased variability. Consequently, it is difficult to replicate the same sensory block in different children, even when administered by the same practitioner.
More studies are thus necessary to guide the type, dosage, and duration of LA and adjuvant administrations to create specific protocols for the various clinical applications of pediatric ESPBs.

Safety profile and adverse events

Regional anesthesia is generally considered safe in the pediatric population, although caution must be exercised, especially when applying these techniques to infants [74]. Furthermore, these techniques can be safely utilized under general anesthesia [75]. In particular, ESPBs appear to be exceptionally safe, as the injection site is very superficial and ultrasound guidance allows for visualization of vital structures such as the neuraxis, pleura, and vascular structures as the needle is inserted. Additionally, it is widely accepted that ESPBs can be conducted safely in patients with coagulopathy [46]. While the standard contraindications and possible complications of any peripheral block, including LA systemic toxicity (LAST), allergic reactions, or motor block, may occur with ESPBs, the available literature documents a promising safety profile in children, with most studies reporting no adverse events or complications such as epidural hematoma, which may occur with neuraxial blocks.
Some minor adverse events such as catheter occlusion, displacement, and unintentional removal have been reported [6,73]. Rare cases of bradycardia or possible LAST have also been reported, but quickly reversed [76,77]. While injection site infections may be a contraindication to peripheral nerve blocks, the possibility of injecting LAs at a site distant from the target in a fascial plane block may allow operators to safely implement ESPBs even in cases of surgical site infection. One other potential complication of ESPBs is a pneumothorax [78]; however, a literature search yielded no documented episodes, and experienced operators hold that ultrasound guidance, fine needle skills, and preventative techniques can minimize this risk [49].

Conclusions

Despite significant interest in ESPBs in the pediatric anesthesia community due to its versatility, low learning curve and safety profile, the available evidence is still anecdotal and non-homogeneous with few rigorous trials, yielding low-quality evidence and no clear protocol to follow. Taken together, the available data suggest that ESPBs may be a valid technique to improve intra- and postoperative pain control and reduce opioid use in pediatric thoracic, abdominal, inguinal, hip, and femur surgeries. Additionally, multiple authors have considered this procedure a valid alternative to other loco-regional techniques and epidural anesthesia. The choice of LA is quite variable among practitioners, with reports of single shot or continuous infusions for different surgeries, and the distribution of injected solutions remains controversial. Hence, more well-designed randomized controlled trials are needed to clarify specific approaches for performing ESPBs for different clinical procedures in the pediatric population.

Notes

Funding

None.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Monica Lucente (Conceptualization; Data curation; Writing – original draft)

Giulia Ragonesi (Data curation; Funding acquisition; Writing – original draft; Writing – review & editing)

Marco Sanguigni (Data curation; Software; Writing – original draft)

Fabio Sbaraglia (Conceptualization; Methodology; Supervision; Writing – review & editing)

Alessandro Vergari (Resources; Validation; Visualization; Writing – review & editing)

Rosa Lamacchia (Resources; Writing – review & editing)

Demetrio Del Prete (Data curation; Writing – review & editing)

Marco Rossi (Conceptualization; Writing – review & editing)

References

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.
2. Muñoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anaesth. 2017; 64:880–2.
crossref
3. Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector spinae plane block versus retrolaminar block: a magnetic resonance imaging and anatomical study. Reg Anesth Pain Med. 2018; 43:756–62.
4. Adler AC, Yim MM, Chandrakantan A. Erector spinae plane catheter for neonatal thoracotomy: a potentially safer alternative to a thoracic epidural. Can J Anaesth. 2019; 66:607–8.
crossref
5. Kaushal B, Chauhan S, Magoon R, Krishna NS, Saini K, Bhoi D, et al. Efficacy of bilateral erector spinae plane block in management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. J Cardiothorac Vasc Anesth. 2020; 34:981–6.
crossref
6. Macaire P, Ho N, Nguyen V, Phan Van H, Dinh Nguyen Thien K, et al. Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery: a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2020; 45:805–12.
crossref
7. Aksu C, Şen MC, Akay MA, Baydemir C, Gürkan Y. Erector spinae plane block vs quadratus lumborum block for pediatric lower abdominal surgery: a double blinded, prospective, and randomized trial. J Clin Anesth. 2019; 57:24–8.
crossref
8. Mostafa SF, Abdelghany MS, Abdelraheem TM, Abu Elyazed MM. Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: a prospective randomized controlled trial. Paediatr Anaesth. 2019; 29:1201–7.
crossref
9. Singh S, Jha RK, Sharma M. The analgesic effect of bilateral ultrasound-guided erector spinae plane block in paediatric lower abdominal surgeries: a randomised, prospective trial. Indian J Anaesth. 2020; 64:762–7.
10. El-Emam EM, El Motlb EAA. Ultrasound-guided erector spinae versus ilioinguinal/iliohypogastric block for postoperative analgesia in children undergoing inguinal surgeries. Anesth Essays Res. 2019; 13:274–9.
11. Villalobos MA, Veneziano G, Miller R, Beltran RJ, Krishna S, Tumin D, et al. Evaluation of postoperative analgesia in pediatric patients after hip surgery: lumbar plexus versus caudal epidural analgesia. J Pain Res. 2019; 12:997–1001.
12. Jöhr M, Berger TM. Caudal blocks. Paediatr Anaesth. 2012; 22:44–50.
crossref
13. Dadure C, Bringuier S, Mathieu O, Raux O, Rochette A, Canaud N, et al. Continuous epidural block versus continuous psoas compartment block for postoperative analgesia after major hip or femoral surgery in children: a prospective comparative randomized study. Ann Fr Anesth Reanim. 2010; 29:610–5.
14. Darling CE, Pun SY, Caruso TJ, Tsui BC. Successful directional thoracic erector spinae plane block after failed lumbar plexus block in hip joint and proximal femur surgery. J Clin Anesth. 2018; 49:1–2.
crossref
15. Balaban O, Koçulu R, Aydın T. Ultrasound-guided lumbar erector spinae plane block for postoperative analgesia in femur fracture: a pediatric case report. Cureus. 2019; 11:e5148.
16. Bosinci E, Spasić S, Mitrović M, Stević M, Simić I, Simić D. Erector spinae plane block and placement of perineural catheter for developmental hip disorder surgery in children. Acta Clin Croat. 2021; 60:309–13.
17. Hernandez MA, Palazzi L, Lapalma J, Forero M, Chin KJ. Erector spinae plane block for surgery of the posterior thoracic wall in a pediatric patient. Reg Anesth Pain Med. 2018; 43:217–9.
18. Nardiello MA, Herlitz M. Bilateral single shot erector spinae plane block for pectus excavatum and pectus carinatum surgery in 2 pediatric patients. Rev Esp Anestesiol Reanim (Engl Ed). 2018; 65:530–3.
crossref
19. Jambotkar TC, Malde AD. A prospective study of the quality and duration of analgesia with 0.25% bupivacaine in ultrasound-guided erector spinae plane block for paediatric thoracotomy. Indian J Anaesth. 2021; 65:229–33.
20. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Özcan M, Gümüş Demirbilek S. Erector spinae plane block for pain management of esophageal atresia in a preterm neonate. J Clin Anesth. 2019; 56:115–6.
crossref
21. Gomez-Menendez JM, Caballero-Lozada FA, Barahona-Cabrera F, Urueta-Gaviria V, Zorrilla-Vaca A. Erector spinae plane block for postoperative analgesia in thoracoscopic lobectomy in a paediatric patient. Anaesthesiol Intensive Ther. 2019; 51:166–7.
crossref
22. Hagen J, Devlin C, Barnett N, Padover A, Kars M, Bebic Z. Erector spinae plane blocks for pediatric cardiothoracic surgeries. J Clin Anesth. 2019; 57:53–4.
crossref
23. Wyatt K, Elattary T. The erector spinae plane block in a high-risk Ehlers-Danlos syndrome pediatric patient for vascular ring repair. J Clin Anesth. 2019; 54:39–40.
24. Aytuluk HG, Gurbuz NS, Karaca E. Erector spinae plane block for anesthesia and analgesia for the insertion of a chest drainage tube in a pediatric patient. Minerva Anestesiol. 2020; 86:1360–1.
crossref
25. Çiftçi B, Ekinci M. Ultrasound-guided single shot preemptive erector spinae plane block for thoracic surgery in a pediatric patient. Agri. 2020; 32:58–9.
26. Gupta A, Gupta N, Choudhury A, Agrawal N. Erector spinae plane block using clonidine as an adjuvant for excision of chest wall tumor in a pediatric patient. Ann Card Anaesth. 2020; 23:221–3.
crossref
27. Swenson Schalkwyk A, Flaherty J, Hess D, Horvath B. Erector spinae catheter for post-thoracotomy pain control in a premature neonate. BMJ Case Rep. 2020; 13:e234480.
crossref
28. Wong J, Navaratnam M, Boltz G, Maeda K, Ramamurthi RJ, Tsui BC. Bilateral continuous erector spinae plane blocks for sternotomy in a pediatric cardiac patient. J Clin Anesth. 2018; 47:82–3.
crossref
29. Moore R, Kaplan I, Jiao Y, Oster A. The use of continuous Erector Spinae Plane blockade for analgesia following major abdominal surgery in a one-day old neonate. J Clin Anesth. 2018; 49:17–8.
crossref
30. Aksu C, Gürkan Y. Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries. J Clin Anesth. 2018; 45:35–6.
crossref
31. Thomas DT, Tulgar S. Ultrasound-guided erector spinae plane block in a child undergoing laparoscopic cholecystectomy. Cureus. 2018; 10:e2241.
crossref
32. Munshey F, Rodriguez S, Diaz E, Tsui B. Continuous erector spinae plane block for an open pyeloplasty in an infant. J Clin Anesth. 2018; 47:47–9.
33. Aksu C, Gürkan Y. Ultrasound-guided bilateral erector spinae plane block could provide effective postoperative analgesia in laparoscopic cholecystectomy in paediatric patients. Anaesth Crit Care Pain Med. 2019; 38:87–8.
crossref
34. Ince I, Aksoy M, Ozmen O. Ultrasound guided erector spinae plane block for postoperative analgesia in a 13 year-old child undergoing abdominal surgery: a new approach. J Clin Anesth. 2019; 55:77–8.
crossref
35. Karaca O, Pınar HU. Efficacy of ultrasound-guided bilateral erector spinae plane block in pediatric laparoscopic cholecystectomy: case series. Agri. 2019; 31:209–13.
36. Aydın T, Balaban O, Demir L. Ultrasound guided erector spinae plane block provides effective opioid-sparing postoperative visceral pain relief after intussusception surgery: a pediatric case report. Agri. 2020; 32:236–7.
crossref
37. Ekinci M, Ciftci B, Güven S, Thomas DT. An alternative and novel usage for ultrasound-guided erector spinae plane block: extracorporeal shock wave lithotripsy in a paediatric patient. Indian J Anaesth. 2020; 64:247–8.
38. Tsui BC, Esfahanian M, Lin C, Policy J, Vorhies J. Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters. Can J Anaesth. 2020; 67:621–2.
crossref
39. Aksu C, Gürkan Y. Sacral erector spinae plane block with longitudinal midline approach: could it be the new era for pediatric postoperative analgesia? J Clin Anesth. 2020; 59:38–9.
40. Ince I, Kilicaslan A, Kutlu E, Aydin A. Combined pericapsular nerve block (PENG) and lumbar erector spinae plane (ESP) block for congenital hip dislocation surgery. J Clin Anesth. 2020; 61:109671.
crossref
41. Baca Q, Lin C, O’Hare K, Golianu B, Tsui B. Erector spinae plane block for pediatric palliative care. Paediatr Anaesth. 2019; 29:386–7.
crossref
42. Kupeli I, Bosinci E, Simić D. Continuous erector spinae plane block infusion in children: a case series. J Clin Anesth. 2021; 71:110251.
crossref
43. Le S, Lo C, Costandi A, Kim E. Bilateral erector spinae plane (ESP) catheters for Ravitch procedure in a pediatric patient with Harrington rods. J Clin Anesth. 2020; 66:109925.
crossref
44. Bonfiglio R, Kotzeva S, Disma N, Wolfler A. Erector spinae block for video-assisted thoracoscopy in a patient with Duchene dystrophy and a prior posterior spinal fusion: a case report. J Clin Anesth. 2021; 75:110445.
crossref
45. Bakshi SG, Awaskar S, Qureshi SS, Gala K. Continuous erector spinae plane block in pediatric patients with intraspinal tumors - case reports. J Anaesthesiol Clin Pharmacol. 2020; 36:558–60.
46. Patel NV, Glover C, Adler AC. Erector spinae plane catheter for postoperative analgesia after thoracotomy in a pediatric patient: a case report. A A Pract. 2019; 12:299–301.
crossref
47. De la Cuadra-Fontaine JC, Concha M, Vuletin F, Arancibia H. Continuous erector spinae plane block for thoracic surgery in a pediatric patient. Paediatr Anaesth. 2018; 28:74–5.
crossref
48. Basaran B, Akkoyun I. Erector spinae plane block for management of major abdominal surgery in a low birth weight preterm neonate. J Clin Anesth. 2020; 61:109641.
49. Aksu C, Gürkan Y. Erector spinae plane block: a new indication with a new approach and a recommendation to reduce the risk of pneumothorax. J Clin Anesth. 2019; 54:130–1.
crossref
50. Aksu C, Gürkan Y. Aksu approach for lumbar erector spinae plane block for pediatric surgeries. J Clin Anesth. 2019; 54:74–5.
crossref
51. Cesur S, Yayik AM, Öztürk F, Ahiskalioğlu A. Does “Aksu approach” make erector spinae plane block technique easier? J Clin Anesth. 2019; 55:142–3.
52. Hernandez MA, Palazzi L, Lapalma J, Cravero J. Erector spinae plane block for inguinal hernia repair in preterm infants. Paediatr Anaesth. 2018; 28:298–9.
crossref
53. Elkoundi A, Bentalha A, Kettani SEE, Mosadik A, Koraichi AE. Erector spinae plane block for pediatric hip surgery -a case report. Korean J Anesthesiol. 2019; 72:68–71.
crossref
54. Govender S, Mohr D, Bosenberg A, Van Schoor AN. A cadaveric study of the erector spinae plane block in a neonatal sample. Reg Anesth Pain Med. 2020; 45:386–8.
crossref
55. Govender S, Mohr D, Van Schoor AN, Bosenberg A. The extent of cranio-caudal spread within the erector spinae fascial plane space using computed tomography scanning in a neonatal cadaver. Paediatr Anaesth. 2020; 30:667–70.
56. Dautzenberg KH, Zegers MJ, Bleeker CP, Tan EC, Vissers KC, van Geffen GJ, et al. Unpredictable injectate spread of the erector spinae plane block in human cadavers. Anesth Analg. 2019; 129:e163–6.
crossref
57. Choi YJ, Kwon HJ, O J, Cho TH, Won JY, Yang HM, et al. Influence of injectate volume on paravertebral spread in erector spinae plane block: an endoscopic and anatomical evaluation. PLoS One. 2019; 14:e0224487.
crossref
58. Ivanusic J, Konishi Y, Barrington MJ. A cadaveric study investigating the mechanism of action of erector spinae blockade. Reg Anesth Pain Med. 2018; 43:567–71.
crossref
59. Yang HM, Choi YJ, Kwon HJ, O J, Cho TH, Kim SH. Comparison of injectate spread and nerve involvement between retrolaminar and erector spinae plane blocks in the thoracic region: a cadaveric study. Anaesthesia. 2018; 73:1244–50.
crossref
60. Schwartzmann A, Peng P, Maciel MA, Alcarraz P, Gonzalez X, Forero M. A magnetic resonance imaging study of local anesthetic spread in patients receiving an erector spinae plane block. Can J Anaesth. 2020; 67:942–8.
61. Zhang J, He Y, Wang S, Chen Z, Zhang Y, Gao Y, et al. The erector spinae plane block causes only cutaneous sensory loss on ipsilateral posterior thorax: a prospective observational volunteer study. BMC Anesthesiol. 2020; 20:88.
crossref
62. De Lara González SJ, Pomés J, Prats-Galino A, Gracia J, Martínez-Camacho A, Sala-Blanch X. Anatomical description of anaesthetic spread after deep erector spinae block at L-4. Rev Esp Anestesiol Reanim (Engl Ed). 2019; 66:409–16.
crossref
63. Elsharkawy H, Ince I, Hamadnalla H, Drake RL, Tsui BC. Cervical erector spinae plane block: a cadaver study. Reg Anesth Pain Med. 2020; 45:552–6.
crossref
64. Harbell MW, Seamans DP, Koyyalamudi V, Kraus MB, Craner RC, Langley NR. Evaluating the extent of lumbar erector spinae plane block: an anatomical study. Reg Anesth Pain Med. 2020; 45:640–4.
crossref
65. Elsharkawy H, Bajracharya GR, El-Boghdadly K, Drake RL, Mariano ER. Comparing two posterior quadratus lumborum block approaches with low thoracic erector spinae plane block: an anatomic study. Reg Anesth Pain Med. 2019; 44:549–55.
66. Aponte A, Sala-Blanch X, Prats-Galino A, Masdeu J, Moreno LA, Sermeus LA. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth. 2019; 66:886–93.
crossref
67. Ohgoshi Y, Ohtsuka A, Takeda Y. Membrane-mediated paravertebral spread after modified erector spinae plane blocks: a cadaveric study. J Clin Anesth. 2020; 65:109880.
crossref
68. Kokar S, Ertaş A, Mercan Ö, Yildirim FG, Taştan ÖA, Akgün K. The lumbar erector spinae plane block: a cadaveric study. Turk J Med Sci. 2022; 52:229–36.
crossref
69. Aksu C, Gurkan Y. Defining the indications and levels of erector spinae plane block in pediatric patients: a retrospective study of our current experience. Cureus. 2019; 11:e5348.
crossref
70. Uysal Aİ, Altıparmak B, Korkmaz Toker M, Gümüş Demirbilek S. Bi-level ESP block for left diaphragma hernia repair in a pediatric patient. J Clin Anesth. 2020; 61:109620.
71. Paladini G, Musella G, Farris G, Mogiatti M, Agosti M, Fusco P, et al. Erector spinae plane block to enhance recovery after thoracoscopic lung lobectomy in infants. Minerva Anestesiol. 2019; 85:1247–9.
crossref
72. Kaplan I, Jiao Y, AuBuchon JD, Moore RP. Continuous erector spinae plane catheter for analgesia after infant thoracotomy: a case report. A A Pract. 2018; 11:250–2.
crossref
73. Munshey F, Caruso TJ, Wang EY, Tsui BC. Programmed intermittent bolus regimen for erector spinae plane blocks in children: a retrospective review of a single-institution experience. Anesth Analg. 2020; 130:e63–6.
74. Walker BJ, Long JB, Sathyamoorthy M, Birstler J, Wolf C, Bosenberg AT, et al. Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network. Anesthesiology. 2018; 129:721–32.
75. Taenzer AH, Walker BJ, Bosenberg AT, Martin L, Suresh S, Polaner DM, et al. Asleep versus awake: does it matter?: Pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network. Reg Anesth Pain Med. 2014; 39:279–83.
76. Crowe AM, Mislovič B. Local anesthetic toxicity following erector spinae plane block in a neonate: a case report. Paediatr Anaesth. 2022; 32:479–81.
crossref
77. Gurbuz H, Demirel A, Ozcakir E. Erector spinae plane block for management of major abdominal and thoracoscopic surgeries in two low-birth-weight preterm neonates. Minerva Anestesiol. 2021; 87:840–2.
crossref
78. Hamilton DL. Pneumothorax following erector spinae plane block. J Clin Anesth. 2019; 52:17.
crossref

Fig. 1.
(A) The ultrasound probe is placed along the midline of the spine and moved laterally to visualize the transverse process. (B) The needle advances to the tip of the transverse process, and LA is injected to dissect the plane deep to the erector spinae muscle.
kja-22279f1.tif
Table 1.
Case Reports in the Literature Search
Case reports Cases Age Indication Timing Intervention Block-related adverse events
Muñoz et al. 2017 [2] 1 7 years Chest wall surgery Postoperative Single shot T8 None reported
14 ml bupivacaine 0.5% with epinephrine 5 μg/ml
Adler et al. 2019 [4] 1 3 weeks Thoracic surgery Preoperative catheter placement Initial postoperative bolus through catheter 0.1% (0.25 mg/kg/h) ropivacaine in infusion for 48 h None
Catheter removed after 48 h
Darling et al. 2018 [14] 1 11 years Iliac crest autograft Preoperative Single shot catheter tip at L2 None reported
Postoperative 15 ml 0.5% ropivacaine intraoperative
11 ml 0.2% ropivacaine every 2 h on postoperative days 0-5
Balaban et al. 2019 [15] 1 6 years Femur fixation Postoperative Single shot T5 None reported
20 ml 0.25% bupivacaine
Bosinci et al. 2021 [16] 2 2 years Hip surgery Preoperative Single shot T4 None reported
7 years Lidocaine 2% 2 ml and levobupivacaine 0.25% 14 ml
Single shot lidocaine 2% 4 ml and levobupivacaine 0.25% 17 ml then continuous infusion levobupivacaine 0.125% 4–8 ml/h via infusion pump
Catheter removed at 72 h
Hernandez et al. 2018 [17] 1 3 years Thoracic surgery Preoperative Single shot T1 None reported
0.1 ml/kg bupivacaine 0.25%
0.1 ml/kg lidocaine 1%
Altıparmak et al. 2019 [20] 1 2 days Thoracic surgery Preoperative Single shot T4 T6 None reported
(32 weeks PCA) 0.5 ml 0.25% bupivacaine (x2)
Gomez-Menendez et al. 2019 [21] 1 13 months Thoracic surgery Preoperative Single shot T4 None reported
5 ml bupivacaine 0.25%
Hagen et al. 2019 [22] 7 37 days– Thoracic surgery Preoperative Single shot None reported
9 years 0.5% bupivacaine + dexamethasone (1 bilateral)
Wyatt and Elattary 2019 [23] 1 17 years Thoracic surgery Preoperative Single shot T5 with catheter placement 25 ml 0.5% ropivacaine None reported
Continuous infusion through catheter 0.2% ropivacaine 8 ml/h during surgery 0.1% ropivacaine 10 ml/h postoperative
Rescue bolus 4 ml bupivacaine 0.25% mixed + 1 ml lidocaine 2% upon arrival in ICU; Catheter removed at 96 h
Aytuluk et al. 2020 [24] 1 5 years Chest tube insertion Preoperative Single shot T6-T7 None reported
7 ml 0.5% bupivacaine
Çiftçi and Ekinci 2020 [25] 1 12 years Thoracic surgery Preoperative Single shot T5 None reported
15 ml 0.25% bupivacaine
Gupta et al. 2020 [26] 1 2 years Thoracic surgery Preoperative Single shot T5 None reported
8 ml 0.375% ropivacaine + 10 μg clonidine
Swenson Schalkwyk et al. 2020 [27] 1 2 days Thoracic surgery Preoperative Catheter T5-T6 with hydrodissection + 2 ml 3% chloroprocaine None
1 ml 0.1% at surgery
Continuous infusion: 1.5% chloroprocaine at 0.25 ml/kg/h
Catheter removed at 140 h
Wong et al. 2018 [28] 17 years Cardiac surgery Preoperative catheter placement and bolus; postoperative PIB Bilateral catheters tip T7 None reported
10 ml 0.5% ropivacaine (x2) preoperative, then postoperative alternating catheter boluses of 10 ml 0.1% ropivacaine every 60 min
Catheter removal at 72 h
Moore et al. 2018 [29] 1 1 year Abdominal surgery Preoperative catheter placement and bolus; postoperative continuous infusion Bilateral catheters T8-T10 None reported
1 ml 0.2% ropivacaine followed by 0.5 ml/h 0.2% ropivacaine intraoperative Postoperative 0.5 ml/h 0.1% ropivacaine until catheter removal 72 h postop
Aksu and Gürkan 2018 [30] 2 6 months Nephrectomy Preoperative Single shot T12 None
7 years 0.5 ml/kg 0.25% bupivacaine
Thomas and Tulgar 2018 [31] 1 11 years Abdominal surgery Preoperative Single shot bilateral T9 None reported
0.25% bupivacaine 0.5 ml/kg (x2)
Munshey et al. 2018 [32] 1 11 months Open pyeloplasty Preoperative Catheter tip T8 None reported
Bolus 0.3 ml/kg ropivacaine 0.2% every hour during surgery, then 0.3 ml/kg ropivacaine 0.5% at end of surgery; Catheter removed at 48 h
Aksu and Gürkan 2019 [33] 3 8, 11, 13 years Laparoscopy Preoperative Single shot bilateral T7 None reported
0.5 ml/kg 0.25% bupivacaine (max 20 ml) (x2)
Ince et al. 2019 [34] 1 13 years Abdominal surgery Preoperative Single shot bilateral L2-3 None reported
LA not specified
Karaca and Pınar 2019 [35] 4 10–14 years Abdominal surgery Preoperative Bilateral single-shot T7 None
Total 2.5 mg/kg bupivacaine
Aydın et al. 2020 [36] 1 9 months Abdominal surgery Postoperative Single shot T10 + T11 None
Bupivacaine 0.25% (3 ml T10 + 3 ml T11)
Ekinci et al. 2020 [37] 1 2 years Shock wave lithotripsy Preoperative Single shot T10 None reported
6 ml 0.25% bupivacaine
Tsui et al. 2020 [38] 1 16 years Spinal surgery Intraoperative surgical catheter placement Bilateral catheter tips at T6 None reported
20 ml lidocaine 0.5% (x2) at end of surgery
Postoperative boluses 20-22 ml 0.5% lidocaine alternating right and left side every 60 min; Catheter removed at 48 h
Aksu and Gürkan 2020 [39] 1 6 months Genital surgery Preoperative Single-shot median sacral None
8 ml of 0.25% bupivacaine
Ince et al. 2020 [40] 1 4 years Hip surgery Preoperative Single shot L4 None
ESPB in combination with pericapsular nerve block 0.25% bupivacaine (total 20 ml 0.25% bupivacaine)
Baca et al. 2019 [41] 1 15 years Palliative pain Catheters placed under general anesthesia in hospital before release to home care Bilateral tunneled catheters T8 (advanced to T12) None
Single shot 11 ml 0.5% ropivacaine
PIB 10 ml 0.2% ropivacaine every 2 h alternating sides
Catheter removed after 7 days
Kupeli et al. 2021 [42] 9 2-10 years Multiple surgery Preoperative Preoperative single shot upon catheter placement, 0.25% levobupivacaine 0.4 ml/kg None reported
Postoperative continuous infusion through perineurial catheter 1-5 ml/h 0.125% levobupivacaine
Level T5 for thoracotomy; T8 for nephrectomy; T12-L2 for appendectomy and inguinal hernia; L1–2 for orchidopexy and ureterocele; and L4 for hip surgery Catheters removed within 24 h after surgery
Le et al. 2020 [43] 1 17 years Ravitch procedure Preoperative Bilateral catheters T5 None reported
20 ml 0.2% ropivacaine preoperative
Continuous infusion 6-8 ml/h ropivacaine 0.15%
Rescue bolus 6 ml ropivacaine 0.15% on each side on postoperative day 1 Catheters removed at 72 h
Bonfiglio et al. 2021 [44] 1 19 years Thoracoscopy Preoperative catheter placement and bolus; postoperative continuous infusion + patient-controlled infusion Single shot T4 None reported
18 ml of 0.25% levobupivacaine + 30 μg of dexmedetomidine
Continous infusion 0.125% levobupivacaine 10 ml/h + PCI 5 ml with 60-min lockout
Catheter removed on postoperative day 3
Bakshi et al. 2020 [45] 2 3 years Spine surgery Preoperative catheter placement; catheter placement on postoperative day 4 Intermittent bolus 6 ml 0.25% levobupivacaine every 8 h for 4 days None
4 years Intermittent bolus of 5 ml 0.25% bupivacaine every 8 h for 4 days
Patel et al. 2019 [46] 1 6 years Thoracic surgery Preoperative Single shot T5 None reported
10 ml of 0.5% ropivacaine
Continuous infusion through catheter 0.2 mg/kg/h ropivacaine
Catheter removed at 96 h
De la Cuadra-Fontaine et al. 2018 [47] 1 3 years Thoracic surgery Preoperative catheter placement and bolus; postoperative continuous infusion + patient-controlled infusion Single shot T9 8 ml of 0.25% levobupivacaine;Continuous infusion 0.1% levobupivacaine 3 ml/h + PCA 1.5 ml with 30-min lockout None reported
Catheter removed at 96 h
Basaran and Akkoyun 2020 [48] 1 1 days Abdominal surgery Preoperative Single shot bilateral T7 None reported
(30 weeks PCA) 0.5 ml 0.25% bupivacaine (x2)
Aksu and Gürkan 2019 [49] 2 11 years Abdominal surgery Preoperative Single shot T11 bilateral None
0.25% bupivacaine 0.5 ml/kg
Aksu and Gürkan 2019 [50] 2 2 years Inguinal hernia repair Preoperative Single shot lumbar ESPB None
5 years 0.25% bupivacaine 0.5 ml/kg (does not specify vertebral level)
Cesur et al. 2019 [51] 5 3–12 years Inguinal hernia repair Preoperative Single shot None reported
0.25% bupivacaine with a volume of 0.5 ml/kg (vertebral level not specified)
Hernandez et al. 2018 [52] 1 2 months Inguinal hernia repair Preoperative Single-shot T6 None
0.2 ml/kg bupivacaine 0.25%
0.2 ml/kg lidocaine 1%
Elkoundi et al. 2019 [53] 1 4 years Hip surgery Preoperative Single shot L2 None reported
0.3 ml/kg 0.25% bupivacaine
Uysal et al. 2020 [70] 1 5 months Diaphragmatic hernia Postoperative Single shot (twice) T6 T10 None
0.5 ml/kg 0.25% bupivacaine
Paladini et al. 2019 [71] 1 5 months Thoracic surgery Preoperative Single shot T4 (twice) None
Postoperative 4 ml 0.2% levobupivacaine after induction
4 ml 0.1% levobupivacaine before emergence
Kaplan et al. 2018 [72] 1 7 months Thoracic surgery Preoperative Single shot T6 None
2 ml of 0.2% ropivacaine for hydrodissection and catheter placement, then continuous infusion through catheter 0.2% ropivacaine 1 ml/h
Catheter removed at 72 h
Gurbuz et al. 2021 [77] 2 1 day Thoraco-abdominal Postoperative; preoperative Single shot T4; T8 Bradycardia 10 min after block (treated with atropine) in 1 case
25 days surgery 0.75 ml 0.2% bupivacaine

ESPB: erector spinae plane block, LA: local anesthetic, ICU: intensive care unit, PCA: post conceptual age, PCI: patient’s controlled infusion.

Table 2.
Case Series in the Literature Search
Case series Cases Age Study design Indication Timing Intervention Block-related adverse events
Kaushal et al. 2020 [5] 80 Mean age 28.5 months Prospective randomized single-blind comparative trial Cardiac surgery Preoperative Single shot bilateral T3 None
1.5 mg/kg 0.2% ropivacaine (x2) vs. no block
Macaire et al. 2020 [6] 50 Mean age 25 months Prospective randomized double blind controlled trial Cardiac surgery Preoperative followed by postoperative programmed intermittent bolus regimen Induction single shot in bilateral T3-T4 catheter Accidental catheter removal or displacement
0.1%-0.2% ropivacaine followed by postoperative PIB 0.1%-0.2% ropivacaine for 48 h vs. sham PIB with saline for 48 h
Aksu et al. 2019 [7] 57 1–7 years Prospective double blind randomized trial Pelvic small surgery Preoperative Single shot L1 None
ESPB vs. single shot quadratus lumborum block 0.5 ml/kg 0.25% bupivacaine
Mostafa et al. 2019 [8] 60 3–10 years Prospective randomized control trial Open splenectomy Preoperative Single shot bilateral T7 None
0.3 ml/kg 0.25% bupivacaine (x2) vs. bilateral sham ESPB 0.3 ml/kg normal saline (x2)
Singh et al. 2020 [9] 40 2–10 years Prospective randomized control trial Lower abdominal surgery Preoperative Single shot bilateral L1 None
0.5 ml/kg 0.25% bupivacaine (x2) vs. no block
El-Emam et al. 2019 [10] 60 6 months- Prospective randomized control trial Unilateral inguinal Preoperative Single shot L1 level ESPB vs. ilioinguinal/iliohypogastric nerve block, 0.5 ml/kg 0.125% bupivacaine + fentanyl 1 μg/ml injectate None
3 years hernia repair
Jambotkar and Malde, 2021 [19] 30 1–12 years Prospective observational study Thoracotomy Preoperative Single shot T4 None
0.25% bupivacaine 0.3 ml/kg
Aksu and Gurkan, 2019 [69] 141 0.25–17 years Retrospective cohort study Thoracic, abdominal and pelvic surgery Preoperative Unilateral (112) or bilateral (29) single shot T4 to S4 None
0.25% bupivacaine 0.5 ml/kg (max 20 ml)
Munshey et al. 2020 [73] 22 11 months–17 years Retrospective cohort study Thoracic, abdominal, hip surgery Preoperative (postoperative for one patient) followed by intraoperative and postoperative programmed intermittent bolus regimen Catheter ESPB (17 unilateral, 5 bilateral; 22 thoracic, 5 lumbar) with median loading dose 0.4 ml/kg ropivacaine 0.5%, intraoperative bolus of 0.3 ml/kg/h ropivacaine 0.2%, postoperative programmed intermittent bolus maximum 0.5 mg/kg/h Local edema and tenderness

ESPB: erector spinae plane block, PIB: programmed intermittent bolus.

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