Erector Spinae Plane Block: A New Option for Managing Acute Axial Low Back Pain in the Emergency Department

Abstract

Aim: To evaluate pain and length of stay outcomes in six patients who received an erector spinae plane block (ESPB) in the emergency department (ED) for low back pain. Materials & methods: A case series of six patients who received unilateral or bilateral ESPB after presenting to the ED for acute atraumatic axial low back pain. Results: The average visual analog scale pain score reduction was 81.8%, and length of stay after ESPB was 73.5 min. No postprocedure opiates in the ED or after discharge were required. Conclusion: The ESPB is a rapid, safe and opiate-sparing option for the treatment of acute low back pain.

Lay abstract

Acute low back pain is one of the most common reasons patients present to the emergency department (ED), and it is often difficult to treat. The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED. This case series looks at outcomes of six patients who presented to the ED with low back pain who were treated with an ESPB that targets the low back muscles. Visual Analog Scale pain score reduction after the procedure ranged between 71 and 100%, with an average of 81.8%. The average length of stay (LOS) prior to the nerve block was 225 min, with a range of 107–480 min. Average LOS after the block was 73.5 min, with a range of 26–180 min. Five of six patients did not have any return ED visits for back pain. All six patients required no opiates after the procedure in the ED or after discharge. These cases show the ESPB is a promising technique that gives emergency physicians a rapid, safe and opiate-sparing option for the treatment of low back pain. ESPBs can result in decreased pain, decreased LOS, decreased opiate requirements and decreased admission for refractory pain.

Keywords::

• acute low back pain
• alternatives to opioids
• axial low back pain
• emergency department
• erector spinae plane block
• low back pain
• opiate sparing
• regional anesthesia

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.