Truncal Blocks#

Erector Spinae Plane (ESP)#

  • Fascial plane block, often @ T5-T7 (near level of angle of scapula)

    • Can cover 3-4 levels above & below block

    • Easy to get view, but narrow ultrasound window/needle alignment makes for technically challenging block

  • Theory: local anesthetic travels along plane & eventually gets into paravertebral space

  • Can be done sitting or lateral. Lateral is more difficult.

  • Commonly used for rib fractures

  • Alternative to thoracic epidural/paravertebral if patient is anticoagulated

Serratus Anterior Plane#

  • Fascial plane block

  • Similar to PECs 1 & 2 Block, but more lateral into axillary line.

  • Alternative to Erector Spinae Plane if rib fractures are anterior

Serratus Anterior Injection

https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/thorax/pectoralis-serratus-plane-blocks/

Transverse Abdominus Plane (TAP)#

  • Fascial plane block, inject between internal oblique & transversus abdominus muscles.

  • Somatic abdominal wall coverage only, no visceral coverage

  • Can be performed subcostal, anterior, lateral, posterior. More lateral/posterior = better coverage.

  • Quadratus lumborum block is similar to a posterior TAP block, but also enters paravertebral space which achieves visceral coverage

abdominal-wall-nerves

tap-injection

tap-location

https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/abdomen/ultrasound-guided-transversus-abdominis-plane-quadratus-lumborum-blocks/

Rectus Sheath Block#

  • Fascial plane block

  • Somatic abdominal wall coverage only, no visceral coverage

  • Alternative to epidural for midline laparotomies