Nerve Block Gallery - Erector Spinae Block for a Traumatic Injury
Caption
A 45-year-old male presented to the ED as a pedestrian struck by a car. He was hit from behind and pinned to a wall briefly. Workup revealed left sided 1st-5th anterior rib fractures, 3rd-7th posterior rib fractures with significant displacement, as well as left C7 and T1 transverse process fractures and a left medial clavicle fracture. An erector spinae block was performed for analgesia. In the first image, the erector spinae muscle layer can be seen sitting atop two levels of transverse processes. The patient was slowly rolled onto the right lateral decubitus. The second clip shows a needle approaching from cephalad and depositing anesthetic into the fascial plane between the erector spinae and transverse process. The patient felt near immediate pain relief at the termination of the procedure. He was subsequently brought to the SICU prior to having a rib plating operation the following day, and received a serratus anterior catheter placed by anesthesia during pre-op. Dr. Makenna Rice, PGY-1, Denver Health Emergency Medicine Residency Dr. Fred Milgrim, Ultrasound Fellow, Denver Health Emergency Medicine