Background and aims Erector spinae plane (ESP) block is a novel technique in which local anesthetic (LA) is injected between the erector spinae muscle and transverse process under ultrasound guidance. It has been used as a postoperative analgesia method in many surgical procedures. The mechanism of action is not clear. There are well-described anatomical gaps in the intertransverse connective tissue that might explain how LA can pass from the ESP into the para-vertebral space. Although it is efficient, in real life there is block failure/lack of efficiency that tells us there might be things to consider about the block. We would like to present our modified technique (ESP-3), which aims to be a more reliable block.

Methods We performed ESP-3 for 6 patients (1-breast surgery with fleb, 4-thoracoscopic pleurodesis and 1-lobectomy). Blocks were performed at sitting position. A linear-ultrasound probe was placed longitudinal parasagittal orientation. After transverse process (TP) was identified, an 22G-echogenic needle (Braun-StimuplexUltra360) was inserted in-plane caudal-to-cranial approach. The needle tip made contact with TP and 10 ml of LA (Bupivacaine) was given to the fascial plane. Then the needle moves from the most proximal part of the TP, past intertransverse ligament and 15 ml of LA is injected just above the superior costotransverse ligament.

Results Before the end of the surgeries, non-steroid anti-inflammatory drug and paracetamol were given. Opioids were not needed. None of the patients complained about the pain. No complication was recorded.

Conclusions Facial plane blocks are promising. They can be as effective as epidurals. With our modified ESP technique, we hypothesized a more consistent and reliable block can be achieved.