Erector Spinae Plane Block

Transcript

• 00:01Welcome to Yale emergency ultrasound
• 00:03nerve block series.
• 00:05Today, we are going to
• 00:06go over the erector spinae
• 00:07plain block.
• 00:08This way, you are ready
• 00:09to block on your next
• 00:11shift. The first step is
• 00:12to go to the cart
• 00:13by the ultrasound station near
• 00:15a sixteen.
• 00:16On the bottom drawer, you
• 00:17will find premade kits to
• 00:19use for nerve blocks.
• 00:22The kits include a sterile
• 00:24probe cover,
• 00:25chloroprep,
• 00:27a saline flush, an echogenic
• 00:29needle,
• 00:30a blunt needle, and a
• 00:31ten cc syringe.
• 00:34Some indications for the rectospinae
• 00:36plain block include chest wall
• 00:38trauma,
• 00:39posterior rib fractures,
• 00:41vertebral compression fractures,
• 00:43back pain, herpes zoster, and
• 00:45renal colic.
• 00:46This block will anesthetize
• 00:48all levels below where we
• 00:50inject.
• 00:50Because of gravity, for example,
• 00:52if you block at T12,
• 00:54the anesthetic will run down
• 00:55the plane,
• 00:56blocking all levels below T12
• 00:59on the side injected.
• 01:01Because this is a large
• 01:03volume block, make sure to
• 01:04have the patient on the
• 01:05telemonitor
• 01:06before you start.
• 01:07Local anesthetic systemic toxicity is
• 01:10rare but life threatening.
• 01:12Have the patient's weight updated
• 01:13in the chart and use
• 01:15MD Calc, local anesthetic dosing,
• 01:17to calculate the maximum dose
• 01:19allowed for this plain block.
• 01:21We recommend using fifteen milliliter
• 01:24of anesthetic and fifteen milliliter
• 01:26of normal saline. You'll be
• 01:28administering
• 01:29two cc every two minutes,
• 01:31keeping an eye on the
• 01:32monitor,
• 01:33looking for signs of last
• 01:35and patient's tolerance.
• 01:39For this plan block, you
• 01:40will need to identify
• 01:42the trapezius,
• 01:43rhomboid, and erector spinae muscles
• 01:45as well as the transverse
• 01:47process.
• 01:48Your needle will make contact
• 01:49with the transverse process and
• 01:51your goal is to inject
• 01:53local anesthetic under the fascia
• 01:55of the erector spinae.
• 01:58Since this is a volume
• 01:59block, you'll need to inject
• 02:01twenty five to thirty cc's
• 02:03of volume in this space.
• 02:07Now we will use our
• 02:08ultrasound to identify the anatomy.
• 02:11Your probe is pointing cephalad
• 02:13in a sagittal orientation.
• 02:15First, identify the spinous process.
• 02:18Move lateral to then identify
• 02:20the transverse process. If you
• 02:22move in more lateral, you'll
• 02:24identify
• 02:24the rib and pleura.
• 02:28Let's demonstrate this on a
• 02:29real patient.
• 02:31First, you will begin in
• 02:32the midline and identify
• 02:34the spinous process.
• 02:35You move laterally to then
• 02:37identify the transverse process.
• 02:40If you move too lateral,
• 02:41you will identify the rib
• 02:43and pleural.
• 02:44Stay sterile. An assistant should
• 02:46push the syringe.
• 02:47Visualize the needle at all
• 02:49times. Once your needle is
• 02:50in the correct position, have
• 02:52your assistant push saline slowly.
• 02:54You should be seeing hydra
• 02:55dissection of the fascial plane.
• 02:58Now you can have the
• 02:59assistant switch to anesthetic.