Ultrasound Guided Erector Spinae Plane Block for Pain Management in the Emergency Department: A Scoping Review.

BACKGROUND

The ultrasound-guided erector spinae plane block (ESPB) is a relatively new regional anesthesia technique increasingly used in the emergency department (ED) for multimodal analgesia.

OBJECTIVES

To summarize the existing literature on ESPBs performed by emergency physicians (EPs).

METHODS

Following PRISMA-ScR guidelines, we searched five databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and CINAHL) from inception to June 10, 2025. Records were screened in duplicate, and data were extracted for quantitative and qualitative synthesis in accordance with best practices.

RESULTS

Of 157 unique records, 42 articles met inclusion criteria, reporting 341 ESPBs performed on 279 patients. Most studies were case reports (25 articles, 60%) or small case series (8 articles, 19%), with only six randomized clinical trials (14%). Common indications included visceral abdominal pain (18 articles, 43%), rib fractures (8 articles, 19%), and low back pain (4 articles, 9.5%). Technical approaches varied widely in terms of block laterality, patient positioning, and transducer type. Adverse events were infrequent (9 cases, 3.2%), with only one suspected case of local anesthetic systemic toxicity (0.4%).

CONCLUSIONS

Emergency physician-performed ESPBs are increasingly described for diverse indications, but the current evidence base is limited and heterogeneous. Further research should focus on standardizing techniques, enhancing safety monitoring, and conducting high-quality studies to support broader implementation in emergency medicine.