What is an ESP Block?

An ESP block (Erector Spinae Plane block) is an ultrasound-guided regional anaesthetic technique in which local anaesthetic is injected into the fascial plane deep to the erector spinae muscle and superficial to the transverse process of the vertebra.

The local anaesthetic spreads within the fascial plane, blocking the dorsal and ventral rami of the spinal nerves over several vertebral levels. This provides analgesia to the chest wall, abdominal wall, or back, depending on the level at which the injection is performed.

Chronic pain applications

ESP blocks are increasingly used for selected patients with:

  • Myofascial thoracic pain
  • Chronic post-thoracotomy pain
  • Post-herpetic neuralgia
  • Chronic abdominal wall pain
  • Cancer-related pain
  • Some cases of lumbar or thoracic back pain

How Does it Work?

The steroid medication helps to decrease inflammation and swelling around the affected nerve roots. The local anaesthetic provides temporary pain relief and helps confirm the source of pain.
By calming the irritated nerve, symptoms such as burning pain and skin sensitivity often improve.

What Happens During the Procedure?

  • Positioning: You will lie on a procedure table, usually on your front.
  • Cleaning and Numbing: The skin over your back will be cleaned with antiseptic, and a small amount of local anaesthetic will numb the area.
  • Guidance: Using live ultrasound guidance, the clinician will carefully guide a fine needle into the muscle plane near the affected nerve.
  • Injection: A mixture of steroid and local anaesthetic is slowly injected.
  • Monitoring: You will be observed briefly after the procedure to ensure you are well enough to go home.
  • The whole process typically takes about 20–30 minutes.

What Should I Expect After the Injection?

  • You may feel some numbness or heaviness in the affected area for a few hours — this is temporary.
  • Pain relief may begin within a few days but can take up to two weeks.
  • Some people experience a brief increase in pain before improvement occurs.
  • Activity: You should rest for the remainder of the day and gradually resume normal activities as tolerated.
  • Follow-up: A review appointment may be arranged to assess your response to the injection.

Benefits

  • Targeted pain relief
  • Improvement in nerve-related symptoms (e.g., burning pain and skin sensitivity to light touch)
  • Helps reduce the need for stronger medications
  • May delay or avoid the need for surgery or other invasive treatments. 

Risks and Side Effects

    Serious complications are uncommon, and every effort is made to minimise risk by performing the procedure under ultrasound guidance.

    Possible risks include:

  • Temporary increase in pain for a few days after the injection.
  • Bruising or bleeding at the injection site.
  • Infection at the injection site (rare).
  • Temporary nerve irritation, causing increased pain, tingling, or numbness (usually short-lived).
  • Allergic reaction to the local anaesthetic, steroid, or other medications used (rare).
  • Very rarely, injury to nearby structures, such as the lung (pneumothorax) or bowel, depending on the site of the injection.
  • Very rarely, nerve injury, which may result in prolonged numbness, weakness, or persistent pain. Permanent nerve damage or paralysis is exceptionally rare, particularly when the procedure is performed by an experienced clinician using imaging guidance.

    Steroid-related effects (usually mild and temporary):

  • Flushing of the face
  • Temporary rise in blood sugar (especially in diabetic patients)
  • Sleep disturbance
  • Mood changes

Important Information

Before the procedure:

  • Inform us if you are on blood thinners (e.g., warfarin, clopidogrel, apixaban) — you may need to stop them temporarily.

  • Inform us about any allergies or infections.

  • Continue taking your usual medications unless advised otherwise.

On the day:

  • Arrange for someone to drive you home after the procedure.
  • Avoid heavy lifting or strenuous activities for 24 hours.

When to Seek Helps

Contact your healthcare provider if you experience:

  • Severe or increasing pain
  • Signs of infection (fever, redness, swelling at the injection site)
  • New onset shortness of breath (attend nearest A&E)
  • Difficulty passing urine