Comparison of Pain Relief and Spread Level Using Two Volumes of High Thoracic Erector Spinae Plane Block: A Prospective Randomized Study

Abstract

The erector spinae plane block (ESPB) is minimally invasive, safer, and technically easy procedure. Although the ESPB is considered an easier technique compared to the neuraxial block, its efficacy in patients with cervical radicular pain is uncertain. This study aimed to identify pain relief in patients with cervical radicular pain and spread level in the craniocaudal direction using fluoroscopic guidance. A total of 157 patients experiencing neck or arm pain caused by cervical spine disease or muscle related issues who underwent T2 ESPBs were included. The patients were injected with 10 mL (ESPB 10 mL group) or 20 mL (ESPB 20 mL group) of local anesthetic mixture containing a contrast medium. The degree of pain relief and disability was assessed using an 11-point numerical rating scale (NRS) and the neck disability index (NDI), respectively. Moreover, the spread level of ESPB in the craniocaudal direction was assessed. The number of patients who demonstrated excellent pain relief (NRS reduction > 50%) was 49 (62.8%) and 52 (65.8%) in the ESPB 10 mL and 20 mL groups, respectively. The total number of vertebral segments in the craniocaudal direction was significantly higher in the ESPB 20 mL group than in the ESPB 10 mL group (4.69 ± 1.31 vs. 5.96 ± 1.03, p < 0.001). Both groups of ESPB demonstrated a significant reduction in NRS and NDI. The distribution of the contrast medium in the ESPB 20 mL group was more extensive than that in the ESPB 10 mL group.