Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims The Erector Spinae Plane (ESPB) efficiency in thoracic and abdominal pain management has been well demonstrated. Since the erector spinae muscle (ESM) extends to the cervical spine, cervical ESPB holds potential addressing painful conditions of the shoulder girdle. Remarkably, cadaveric studies have found that injection at cervical levels consistently stained brachial plexus (BP) roots and dorsal rami.

Methods A 46-years-old woman who had undergone lumpectomy and lymph node removal along with chemotherapy for left breast cancer eight years ago presented to chronic pain consultation. The patient reported severe hyperalgesia and allodynia in the trapezius region and left shoulder, particularly along the ulnar nerve pathway. Her current pain management regimen included gabapentin, tapentadol, clonazepam, escitalopram and lorazepam. After obtaining written informed consent, ultrasound-guided cervical ESPB at C6-C7 and ulnar nerve block at the mid-arm point were performed, with 14 and 6 ml of 0.2% ropivacaine, respectively, supplemented with 8 mg of intravenous dexamethasone.

Results At the one-month follow up appointment, the patient reported a significant improvement in shoulder pain and a complete resolution of pain along the ulnar nerve pathway, enabling a significant reduction in rescue analgesics frequency.

Conclusions Cervical ESPB presents as a promising alternative in managing chronic shoulder pain compared to other interventional procedures. Its mechanism might involve the spread of local anesthetic across multiple vertebral levels within the musculofascial plane deep to the ESM, reaching C5 to C7 roots anteriorly. Despite our successful results, further investigations are needed.