Erector spinae plane block for post-cesarean delivery analgesia

Cesarean delivery (CD) is the most common surgical procedure in the world, with rates of up to 40% in some countries.1 Postoperative pain is an important complication and a concern of these patients.2 It is a modifiable risk factor for the development of chronic postsurgical pain, which can affect up to 18% of CDs.3 Effective analgesia can mitigate adverse effects, and facilitate early mobilization, increase breastfeeding success and improve patient satisfaction.
Cesarean delivery is most commonly performed under spinal anesthesia.4 Intrathecal opioids in this setting are often used to provide postoperative analgesia. However, their use is not always appropriate5,6 and regional blocks are a suitable alternative in some situations. Peripheral nerve blocks have become vital for multimodal opioid-sparing analgesia in a multitude of surgical procedures.7 However, the usefulness of nerve-blocks for postoperative analgesia after CD has not been clearly demonstrated. The transversus abdominis plane block (TAPB) and quadratus lumborum block (QLB) has been studied in this patient population, but side effects and limited efficacy have restricted their usage in clinical practice.7 The erector spinae plane block (ESPB) has shown promise as an alternative to neuraxial blockade for a variety of thoracic and abdominal procedures.8 Local anesthetic injected deep to the erector spinae muscle in the paraspinal region can provide somatic and visceral analgesia due to anterior spread through the paravertebral space to the ventral and dorsal rami of the spinal nerves and the white and gray ventral rami communicans (Figs. 1 and 2)9. Since a major limitation of both TAPB and QLB blocks is lack of visceral analgesia, this characteristic of the ESPB could make it a superior technique post CD.