Case Report Presentation of Ultrasound-guided Erector Spinae Plane Block in Shoulder Surgery: Three Patients and Two Different Results

Abstract

Erector spinae block (ESPB) is an effective therapy for chronic shoulder pain. However, ESPB has not been used as a postoperative analgesia method in shoulder surgeries. In this case report, we report three patients undergoing shoulder surgeries that received ESPB preoperatively for postoperative analgesia. All patients had relief of preoperative pain and no associated motor block. Two of the patients manifested with low maximum pain scores (4/10, 3/10) on a numeric rating scale (NRS). The other patient reported a maximum pain score of 8/10 on NRS. While this patient's shoulder mobility immediately improved after ESPB application, the ESPB did not provide adequate analgesia for the postoperative period. The use of the ESPB for acute postoperative analgesia after shoulder surgery is novel and clinically interesting. However, postoperative analgesia was not completely opioid-sparing. Consequently, the efficiency of ESPB at the level of T2 for postoperative analgesia should be considered for surgeries that involve the shoulder cap given the possible inadequate migration of local anesthetic into the cervical plexus. Clinicians should carefully consider an ESPB as a postoperative analgesic option when considering shoulder operations and the possibility for the incomplete spread of local anesthetic in targeted neural structures.