Continuous erector spinae plane block for abdominal visceral cancer analgesia in the emergency department: the case for catheters

Abdominal visceral cancer pain is a challenging oncology presentation to treat in the ED. Current emergency oncologic pain management strategies focus largely on parenteral opioid administration, although ultrasound-guided regional anaesthesia has the potential to provide more targeted, superior and long-lasting analgesia without comparable adverse side effects. In particular, a continuous erector spinae plane block (ESPB) performed between T6 and L2 represents a promising analgesic tool in this patient population. Anterior spread of local anaesthetic from the erector spinae plane to the paravertebral space may anaesthetise abdominal visceral sensory afferents travelling centrally within the thoracolumbar spinal nerves and the sympathetic chain at this level, thereby directly blocking pain conduction stemming from the gastrointestinal tract. While emergency physicians are becoming well versed in single-shot nerve blocks, continuous nerve blockade with catheter placement has yet to be readily adopted. The continuous ESPB for malignancy-related abdominal pain has the potential to not only reshape established oncologic pain management paradigms but also serve as the stepping stone for emergency physician adoption of continuous nerve blocks.