The Sacral Erector Spinae Plane Block: A Narrative Review

Area of Science:

• Regional Anesthesia
• Pain Management
• Surgical Analgesia

Background:

• The sacral erector spinae plane (S-ESP) block is a novel regional anesthesia technique targeting sacral dermatomes.
• It has emerged as a potential option for perioperative analgesia in sacral, perineal, and pelvic surgeries since its first report in 2019.

Purpose of the Study:

• To critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block.
• To outline its mechanisms, approaches, efficacy, safety, and identify research gaps.

Main Methods:

• A narrative review integrating anatomical descriptions, sonographic techniques, and RCTs.
• Comprehensive literature search in major databases (PubMed, Embase, Scopus, Web of Science, Ovid) up to July 21, 2025.
• Inclusion of full-text RCTs on ultrasound-guided S-ESP blocks for perioperative analgesia.

Main Results:

• Fourteen RCTs (2023-2025) included pediatric and adult populations for various surgeries.
• Pediatric S-ESP blocks generally showed longer time to first analgesia and reduced consumption compared to caudal/penile blocks.
• Adult S-ESP blocks consistently reduced pain scores and opioid requirements.

Conclusions:

• Midline and paramedian S-ESP techniques appear feasible, safe short-term, and provide relevant analgesia for selected pediatric, anorectal, and orthopedic surgeries.
• Heterogeneity in techniques, small sample sizes, and limited indications restrict generalizability.
• Large, multicenter RCTs with standardized protocols are necessary to optimize S-ESP block use and compare it with established techniques.