Pain out of plane: Lumbar erector spinae block redefining analgesia for acute soft tissue injury in emergency department.

Abstract

Introduction: Soft tissue injuries resulting from trauma (motor vehicle collisions, falls, etc.) are frequently present to the Emergency Department. While opioid analgesia is commonly used, its side effects and dependence potential underscore the need for alternative approaches (1). The erector spinae plane block (ESPB) is a regional anesthesia technique that involves the injection of local anesthetic into the fascial plane deep to the erector spinae muscles. This case report highlights the effective use of lumbar ESPB in a patient with severe soft tissue pain who was unresponsive to opioids, showcasing its potential as a safe, rapid, and non-opioid alternative for acute pain management in the ED.

Case: A 32-year-old man presented to the ED with complaints of intense lower back pain radiating to the left lower quadrant after a history of fall from height. The patient was found to have soft tissue injury on imaging. The only concern the patient had was severe pain, which was unresponsive to opioids. Erector spinae plane block was given at L1. The patient experienced rapid and substantial pain relief within 10 min of ESPB administration, with a Defense Veteran Pain Rating Scale (DVPRS) score reduction of 2/10 and then 0/10 within an hour. This was the first time, to the best of our knowledge, that ESPB was given at the lumbar vertebrae for soft tissue injuries in the emergency department.

Conclusion: The Erector Spinae Plane Block (ESPB) is a minimally invasive, effective alternative for managing acute soft tissue pain in emergency care, reducing opioid use, and enabling early mobilization. This case highlights its potential as a regional anesthetic in soft tissue injury and underscores the need for further research to expand its applications in acute care. Lumbar ESPB may serve as an alternative intervention for acute, intractable soft tissue pain in emergency care, especially in cases where standard analgesics are insufficient. When performed correctly and with suitable patient selection, it serves as an important tool in the arsenal of regional anesthesia practitioners anesthesia.