T1 erector spinae plane block for first rib resections in patients with thoracic outlet syndrome: a case series

An erector spinae plane block (ESPB), in which a local anesthetic is injected into the plane anterior to the erector spinae muscles, is a relatively new technique for delivering regional anesthesia and is typically performed in the mid-thoracic region. ESPBs demonstrate great potential to control regional neuropathic pain, and, accordingly, may be particularly effective at the T1 level for controlling pain in patients undergoing first rib resections for thoracic outlet syndrome (TOS). Four patients undergoing first rib resections for TOS were administered an ultrasound-guided ESPB at the T1 level. Two patients received the injection sitting upright without general anesthesia; the other patients received the block in the lateral decubitus position while under general anesthesia. Each patient's postoperative pain was adequately controlled, and no complications were observed. T1 ESPBs offer the potential to mitigate postoperative pain. Better pain management may decrease the need for opioids and shorten recovery times. As such, further investigation to establish the safety and efficacy of T1 ESPBs in this patient population can greatly improve patient outcomes.