ESP Block vs. Paravertebral Block [WcRAPM Paris 2023]

This is my presentation from a Pro-Con session with Prof Manoj Karmakar at the World Congress of Regional Anesthesia and Pain Medicine held in Sep 2023 in Paris.
My aim was primarily to dispel the common myths that surround the ESP block, to show that the ESP and paravertebral blocks are closely related, and to provide some tips on how to make the ESP work better for our patients.
00:25 - Process of discovery
01:10 - Updated anatomy
03:15 - MRI evidence
05:28 - Analgesia vs cutaneous block
08:21 - Systemic effect?
09:40 - Why choose ESP
12:28 - Spectrum of ESP-to-PVB
13:50 - US targets in ESP-ITP-PVB
15:21 - Dorsal rami vs Ventral rami coverage
16:49 - Lateral-medial axis of imaging and needling
18:59 - Conclusion

[@AG-yh4br]

A FANTASTIC speaker, a superb scientist.

[@M_J_nan]

I really like the way you share your knowledge! I've learnt a lot from all your tutorials as a self taught "older" anesthetist. All trainees I tutor are recommended to use your videos to get valuable input when they progress. The seniour colleagues interested in improving their technique are all subscribed I believe. Thank you for your time and effort!

[@KiJinnChin]

Thank you for the kind words. I’m so glad you find the material useful. It’s a privilege to be able to share some of what I have learnt, and a responsibility I take seriously.

[@AG-yh4br]

Dear Dr ki-Jinn Chin
Thanks for sharing

[@shinyuetchong4070]

Love this! Merci Beaucoup!

[@ess205]

With this deeper version of ESP, do you change the volume administeres? Does it change how you approach anticoagulation?

[@jpdabass]

One more great lecture, thank you. From what I get, it is acceptable to say that an ESP block will consistently block the posterior rami of the spinal nerves with the linear diffusion pattern of LA deep to the ESM fascia but if we're performing an ESP block aiming for the anterior rami/DRG/sympathetic chain a deeper spread is required - which could sometimes walk on the edge of an ITP block. I would not expect to have multilevel ITP-like spread from a single ESP injection. From this point of view, would you consider to perform ESP blocks with multiple injections (as it can be done with paravertebral blocks?). Thank you, again.

[@KiJinnChin]

You could most certainly do multi-levelESP/ITP blocks, and in fact, the relative simplicity of this versus a PVB, means that it is less daunting than trying to perform multi-level PVBs. I don't know that it is necessary to do it at adjacent levels; I might suggest that doing them 2 levels apart is adequate.