The mechanism of action of erector spinae plane block is not enigmatic: it is intravenous local anaesthetic effect by proxy

Editor—We read with interest the recent editorial in the British Journal of Anaesthesia by Pawa and colleagues. 1 Pawa A. King C. Thang C. White L. Erector spinae plane block: the ultimate 'plan A' block?. Br J Anaesth. 2023; 130: 497-502 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar We wholeheartedly agree with the authors' conclusion that the erector spinae plane block (ESPB) does not qualify as an ‘Ultimate Plan A’ block. Despite this endorsement, we would like to comment on a few issues. Erector spinae plane block: the ultimate ‘plan A’ block?British Journal of AnaesthesiaVol. 130Issue 5PreviewThe erector spinae plane block (ESPB) is one of seven ‘Plan A’ blocks proposed by Regional Anaesthesia UK, covering the key areas of commonly encountered surgeries and acute pain. Unlike the other six blocks, the ESPB can be performed at all levels of the spine and provides analgesia to most regions of the body, leading to the argument that the ESPB is the ultimate Plan A block. Current studies show a high level of evidence supporting use in thoracoabdominal surgery but a lack of benefit in upper and lower limb surgery compared with local infiltration and other Plan A blocks. Full-Text PDF