Sacral Erector Spinae Plane Block: Computed Tomography Imaging in a Hip Fracture Patient

The sacral erector spinae plane (ESP) block, performed by injecting local anesthetic deep to the sacral multifidus, may spread cephalad to lumbar levels and anteriorly to sacral roots. We report an 88-year-old patient undergoing hip fracture surgery in whom a sacral ESP block was performed at S1, injecting 20 mL 0.2% ropivacaine with 20 mL iomeprol (300 mg·mL⁻¹). Computed tomography (CT) scan at 120 minutes showed spread to L2, involving L4-L5 and S2-S3 roots and possibly the sciatic nerve. Analgesia was effective with only paracetamol for 48 hours. Further imaging and anatomical studies are warranted.