Erector Spinae Plane Block for Intercostal Pain related to Cervical Spinal Cord Ependymoma: A Case Report

The erector spinae plane (ESP) block is a relatively novel technique in the field of regional anesthesia and pain management. In the original 2016 case report by Forero et al, the ESP block demonstrated extensive neuropathic pain relief of thoracic origins. Although ESP blocks have proven to be a useful modality for managing perioperative, postoperative, and chronic refractory pain of the thoracoabdominal region, its use indication regarding pain therapy of the cervical region has not yet been clearly elucidated.

A 50-year-old woman with a history of intercostal neuralgia and central pain related to ependymoma and syrinx of the cervical spinal cord presented with exacerbation of chronic postsurgical pain located in the right thoracic region at approximately T8-T11 levels. Given that her pain was refractory to other therapeutic modalities, the patient elected to have an ultrasound-guided right-sided ESP block at the T8 level. Immediately relief was felt after the procedure and was sustained at a follow-up visit. The patient reported 90% improvement of her pain as well as 90% improvement of functionality on her right side. She was extremely satisfied with the results and reported a decreased pain level, at 0 to 1 out of 10.

Although the ESP block was initially described for thoracic pain control, our findings demonstrate that it may also be a beneficial therapeutic option in the management of pain from cervical origin. Our experience with the block showed immediate analgesic efficacy in our patient and provided significant symptomatic relief without the need for opioid rescue therapy. Further investigation is needed to determine its long-term efficacy and safety profile.