Sir,
We read with interest the recent article by Vadera and colleagues “Erector spinae plane block: Anatomical landmark- guided technique”.[1] Authors presented a novel technique of erector spinae plane (ESP) block using anatomical landmarks.
We have described a more inferiorly located anatomical landmark-guided ESP block prior to Vadera et al. observation, for perioperative pain control in a patient with severe aortic stenosis undergoing an emergency abdominal surgery.[2] Similarly, to Vadera et al. technique, ESP block was performed in sitting position using the spinous process of the 10th thoracic vertebra as a reper. An ipsilateral point to the side to be operated was then marked 3 cm lateral from the cephalic edge of the spinous process.
As a guard, the forefinger was placed at the 35 mm depth mark on the needle to be advanced. Contact with the transverse process was noted at 3 cm depth. Unlike Vadera et al. observation, ultrasound was not used to confirm the spread of local anesthetics due to its unavailability but the adequacy of blockade was assessed clinically using pinprick test.
Although ESP block performed using anatomical landmarks can provide adequate anesthesia, for safety purpose we suggest using it in lower levels and only as an alternative to ultrasound guided technique in high-risk patients keeping in mind the benefit-risk balance.
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Conflicts of interest
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References
- 1.Vadera HK, Mistry T. Erector spinae plane block: Anatomical landmark-guided technique. Saudi J Anaesth. 2019;13:268–9. doi: 10.4103/sja.SJA_780_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Elkoundi A, Chouikh C, Baite A, Bensghir M, Bakkali H, Lalaoui SJ. Successful erector spinae plane block without ultrasound guidance in a severely cardiovascular compromised patient. J Clin Anesth. 2019;53:50. doi: 10.1016/j.jclinane.2018.10.002. [DOI] [PubMed] [Google Scholar]