419: Erector Spinae Plane Block As An Emerging Modality For Shoulder Pain: A Prospective Study

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Developing methodology/technology, Pharmacological treatments, Treatment/management

Background and Aims: AIM:
To evaluate the role of Erector Spinae Plane Block in the management of shoulder pain.

OBJECTIVES:
Primary

1. Assessment of pain score using Numeric Pain Rating Scale(NPRS) at 4,8and 12 weeks.
2. To evaluate the improvement of quality of life by disability score (Shoulder Pain and Disability Index=SPADI) at 4,8and 12 weeks.

Secondary

1.To evaluate complications/ adverse effect of block.
2.Analgesic Requirement.
Prevalence of shoulder pain is around 20%, significantly higher in elderly causing significant morbidity (1). It is very important to treat as it will impact the quality of life. Not all patients respond to present pain management alternatives (2). The need for newer and better alternative therapeutic technique needs consideration. Since the erector spinae plane (ESP) block has been described in the successful management of both thoracic and abdominal pain, and as it extends to the cervical spine, the ESP block may be potentially useful(3).

Methods: A prospective clinical study
sample size-18

Inclusion criteria -
•Age> 18years.
•Shoulder pain any aetiology > 3 months.
•Lack of response to medication, subdeltoid / intra-articular injections.
•Numeric Pain Rating Scale >5 ,
•Restricted range of motion of the shoulder joint.
Exclusion criteria-
•Patients requiring surgery.
•Pain due to malignancy, cervical radicular pain.
•Coagulopathy.
•Local skin infection.
•Allergy to local anaesthesia.

•Initial NPRS and disability score(SPADI) noted, informed written consent obtained.
•Patient placed in prone position , high-frequency linear transducer placed in longitudinal orientation.
•10-cm 22G needle inserted in-plane in caudal-to-cranial direction to place the needle tip between the posterior fascia of the erector spinae muscle and T2 transverse process ,hydro-dissection with 0.5-1 mL of normal saline.
•20 mL of 0.25% bupivacaine + 40 mg of methyl-prednisolone acetate injected.
•NPRS noted immediately and 24 hours post procedure.
•Followed up for 12 weeks,NPRS and disability score(SPADI) noted every month during follow up.

Results: •In this study we evaluated the effectiveness of ESPB, decrease in NRPS, SPADI which was significantly decreased from day 1 of procedure and with peak effects being noted upto 12th week.
•Mean NRPS was 7.38 on day 0 which reduced to 1.2 on 12th week of follow up.
•Only 7 patients needed additional analgesics which was decreased from their previous requirement of oral medications and was slowly being tapered.
•Patients aged 61-75years , predominantly females (63%) had complaints of shoulder pain compared to male patients. This reflects the higher prevalence of chronic and functional pain in women(1). Only 3 patients had non significant complications like dizziness.

Conclusions: Erector spinae plane block (ESPB) demonstrates significant potential as an effective, safe, and minimally invasive intervention for chronic shoulder pain refractory to conventional management. Our study concludes marked and sustained reduction in pain (NPRS) and disability (SPADI) beginning from the immediate post-procedural period and persisting up to 12 weeks, along with a notable decline in additional analgesic requirements. The low incidence of minor complications further supports its safety profile. These findings support the growing body of evidence favouring ESPB technique as a part of multimodal pain management strategies.

References: 1. Lotero MAA, Aguilar MAM, Díaz RCR, Montoya LP. Comparison of two interventional techniques for the treatment of chronic shoulder pain. Colomb J Anesthesiol. 2018 Jan 1;46(1):26–31.
2. Forero M, Rajarathinam M, Adhikary S Das, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Can J Anesth. 2018 Mar 1;65(3):288–93.
3. Viderman D, Sarria-Santamera A. Erector spinae plane block in chronic pain management: a scoping review. Tumori. 2021 Oct 1;107(5):458–67.

4. Lee SH, Choi HH, Lee DG. Effectiveness of new nerve blocks method on the articular branches of the suprascapular and subscapular nerves to treat shoulder pain. Medicine (Baltimore). 2020;99(35):e22050. doi:10.1097/MD.0000000000022050
5. Kapukaya F, Ekinci M, Ciftci B, Atalay YO, Gölboyu BE, Kuyucu E, Demiraran Y. Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy. BMC Anesthesiol. 2022 May 12;22(1):142. doi: 10.1186/s12871-022-01687-5. PMID: 35550031; PMCID: PMC9097375.
6. Arcila Lotero, Mario Andrésa; Mejía Aguilar, María Adelaidab; Rivera Díaz, Roberto Carloa,b; Montoya, Liliana Patriciaa,c. Comparison of two interventional techniques for the treatment of chronic shoulder pain. Colombian Journal of Anesthesiology: January-March 2018 - Volume 46 - Issue 1 - p 26-31 doi: 10.1097/CJ9.0000000000000005
7. Ciftci B, Ekinci M, Gölboyu BE, Kapukaya F, Atalay YO, Kuyucu E, Demiraran Y. High Thoracic Erector Spinae Plane Block for Arthroscopic Shoulder Surgery: A Randomized Prospective Double-Blind Study. Pain Med. 2021 Apr 20;22(4):776-783. doi: 10.1093/pm/pnaa359. PMID: 33155041.
8. Cho, Hobum MD; Chung, Jiwon MD, PhD; Jang, Younsil MD; Song, Sanghoon MD; Yoo, Jaehwa MD; Kim, Sangho MD, PhD; Park, Sunyoung MD, PhD; Kim, Mungyu MD, PhD∗. Analgesic effects of erector spinae plane block can differ according to needle size: A case report. Medicine: September 03, 2021 - Volume 100 - Issue 35 - p e27142 doi: 10.1097/MD.0000000000027142
9. Shanthanna, H., Czuczman, M., Moisiuk, P., O’Hare, T., Khan, M., Forero, M., Davis, K., Moro, J., Vanniyasingam, T., Foster, G., Thabane, L. and Alolabi, B. (2022), Erector spinae plane block vs. peri-articular injection for pain control after arthroscopic shoulder surgery: a randomised controlled trial. Anaesthesia, 77: 301-310. https://doi.org/10.1111/anae.15625

Presenting Author: Rashmi N S
Submitting Author: Rashmi N S

Senior Author: Sandeep Kadam

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Pradhan K Monnaiah: Anesthesiology and Pain - Dr DY Patil Medical College, Kolhapur
• Sandeep Kadam: Anesthesiology and Pain - Dr DY Patil Medical College, Kolhapur
• Rashmee Chavan: Anesthesiology and Pain - Dr DY Patil Medical College, Kolhapur