Initial experience of erector spinae plane block in patients undergoing breast surgery: A case series

Postoperative pain after breast surgery is difficult to manage owing to its complex innervation. Recently, erector spinae plane (ESP) block, an interfacial block, has been described to provide pain relief after thoracic and abdominal surgeries, multiple rib fractures, and neuropathic thoracic pain. Local anesthetic injected in the erector spinae muscle sheath at the level of the 5th thoracic transverse process is distributed cranially and caudally along the sheath, and to the paravertebral space through apertures in the anterior sheath wall. This may block the dorsal and ventral rami of the thoracic spinal nerves at multiple vertebral levels and the rami communicantes transmitting autonomic fibers to and from the sympathetic ganglia, causing multidermatomal somatic and visceral analgesia. The present case report demonstrates the adequate perioperative analgesia provided by the ultrasound-guided ESP block in patients undergoing various breast surgeries.