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Daring discourse: should the ESP block be renamed RIP II block?
  1. PA Lonnqvist1,
  2. Manoj Kumar Karmakar2,
  3. Jonathan Richardson3 and
  4. Bernhard Moriggl4
  1. 1 Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
  2. 2 Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
  3. 3 Department of Anaesthetics and Pain Medicine, Bradford Royal Infirmary, Bradford, UK
  4. 4 Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
  1. Correspondence to Dr PA Lonnqvist, Physiology & Pharmacology, Karolinska Inst, Stockholm 17177, Sweden; Per-Arne.Lonnqvist{at}


During the time period 1984 to the turn of the millennium, interpleural nerve blockade was touted as a very useful regional anesthetic nerve blockade for most procedures or conditions that involved the trunk and was widely practiced despite the lack of proper evidence-based support. However, as an adequate evidence base developed, the interest for this type of nerve block dwindled and very few centers currently use it—thereby to us representing the rest in peace (RIP) I block. Unfortunately, we get a deja-vù sensation when we observe the current fascination with the erector spinae plane block (ESPB), which since 2019 has generated as many as 98 PubMed items. This daring discourse point out the lack of a proper evidence base of the ESPB compared with other established nerve blocking techniques as well as the lack of a proven mechanism of action that explains how this nerve block technique can be effective regarding surgical procedures performed on the front of the trunk. Emerging meta-analysis data also raise concern and give cause to healthy skepticism regarding the use of ESPB for major thoracic or abdominal surgery. Against this background, we foresee that ESPB (and variations on this theme) will end up in a similar fashion as interpleural nerve blockade, thereby soon to be renamed the RIP II block.

  • analgesia
  • anesthesia
  • conduction
  • pain
  • postoperative
  • acute pain

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  • Contributors PAL: underlying idea and manuscript writing. MKK: manuscript writing and manuscript reviewing. JR: manuscript reviewing, language revision, expertise in interpleural blockade. BM: manuscript writing, manuscript reviewing, expertise in relevant anatomy and cadaver dissection. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.