Erector Spinae Plane Block for Back Pain

Overseen By Michelle Santangelo, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rush University Medical Center

Disqualifiers: Non-English/Spanish, Incarceration, Pregnancy, Allergies, Critical illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 1 day

62 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether the erector spinae plane block (ESPB), a type of nerve block, can reduce pain in people with low back pain visiting the emergency department. The researchers aim to determine if this treatment not only eases pain immediately but also reduces pain and disability and improves the ability to return to normal activities after a week. Participants will receive either the ESPB or a placebo injection for comparison. Ideal candidates are adults who have experienced low back pain for less than six weeks.

As an unphased trial, this study allows participants to contribute to innovative pain management research.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that the erector spinae plane block is safe for treating low back pain?

Research has shown that the erector spinae plane block (ESPB) can effectively reduce pain. In one study, a patient experienced about 90% improvement in low back pain. Another study found that ESPBs reduced the need for opioid painkillers without altering pain levels, offering a safer way to manage pain.

Regarding safety, current information is mostly reassuring. However, safety data remains limited, especially for individuals taking blood-thinning medications. Most safety information comes from small studies, so researchers do not yet have large-scale safety data. Still, existing reports have not shown major safety concerns.

For those considering ESPB, it's important to know that while it appears promising, more research is needed to fully understand its safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

The Erector Spinae Plane Block is unique because it targets back pain through a novel mechanism: a regional anesthetic technique that directly numbs the nerves around the spinal column. This approach is different from typical treatments like oral pain medications or physical therapy, which don't specifically block nerve signals. Researchers are excited because this technique has the potential to provide pain relief more directly and immediately, reducing the need for systemic painkillers and their associated side effects. Additionally, it might offer a non-invasive alternative to more invasive procedures like spinal injections or surgery.

What evidence suggests that the erector spinae plane block is effective for low back pain?

Research has shown that the erector spinae plane block (ESPB), which participants in this trial may receive, can greatly reduce pain. In one study, 78% to 83% of patients reported excellent to moderate relief from low back pain after receiving the ESPB. Another report highlighted a patient who experienced about 90% improvement in pain. Studies have also found that ESPB significantly lowered pain scores within a few hours, reducing the need for additional pain medication. Overall, the ESPB appears to be very effective in managing low back pain and helping patients feel better quickly. ^{1 3 6 7 8}

Who Is on the Research Team?

Michael Gottlieb, MD

Principal Investigator

Rush University Medical Center

Are You a Good Fit for This Trial?

This trial is for adults over 18 who come to the emergency department with low back pain that's been there for less than six weeks. It's not specified, but typically people with certain health conditions or those on conflicting medications might be excluded.

Exclusion Criteria

Are incarcerated

Have a known pregnancy

Are allergic to amide-type local anesthetics

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 day

1 visit (in-person)

Treatment

Participants receive either the ESPB or a placebo injection in the emergency department

1 day

1 visit (in-person)

Immediate Follow-up

Participants report their pain scores for up to 120 minutes post-intervention

120 minutes

1 visit (in-person)

Follow-up

Participants report their pain, disability, and return to work at 7 days

7 days

1 visit (virtual or in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Erector Spinae Plane Block

Trial Overview

The study is testing if an erector spinae plane block (ESPB), a type of nerve block, can reduce acute and longer-term low back pain compared to a sham procedure (placebo injection). Participants will report their pain up to two hours after treatment and again at seven days.

How Is the Trial Designed?

Group I: Erector Spinae Plane Block Experimental Treatment 1 Intervention

This group will receive the erector spinae plane block

Group II: Sham Procedure Placebo Group 1 Intervention

This group will receive a sham injection.

Who Is Running the Clinical Trial?

Rush University Medical Center

Lead Sponsor

Trials

448

Recruited

247,000+

Published Research Related to This Trial

The Erector Spinae Plane Block (ESPB) is a new technique for pain management that involves injecting local anesthetic between the erector spinae muscle and the transverse process, which has been generally considered safe.

Despite its safety profile, there is a potential for complications, as demonstrated by a case where a patient developed priapism following the ESPB, highlighting the need for careful monitoring as the technique becomes more widely used.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Priapism following erector spinae plane block for the treatment of a complex regional pain syndrome. Elkoundi, A., Eloukkal, Z., Bensghir, M., et al.[2019]

In a study involving patients undergoing thoracotomy, a 30 ml dose of bupivacaine for the erector spinae plane block (ESPB) provided significantly better pain relief compared to a 20 ml dose, as indicated by lower visual analog scale (VAS) scores for both resting and coughing at multiple time points post-surgery.

Both doses of bupivacaine resulted in similar side effect rates, suggesting that the 30 ml dose is not only more effective for pain management but also safe for use in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of analgesic efficacy of different local anesthetic volumes for erector spinae plane block in thoracotomy patients; a prospective randomized trial. Zengin, M., Sazak, H., Baldemir, R., et al.[2023]

The erector spinae plane (ESP) block significantly reduces pain scores in the first 48 hours after lumbar spine surgery, both at rest and during activity, based on a systematic review of 22 randomized controlled trials involving 1,327 patients.

Using the ESP block also leads to decreased opioid consumption and fewer patients needing rescue analgesics, which contributes to lower rates of postoperative nausea and vomiting and higher patient satisfaction scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block on Postoperative Pain and Opioid Consumption After Lumbar Spine Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Wilson, AA., Schmid, AM., Pestaña, P., et al.[2023]

The erector spinae plane (ESP) block significantly reduced postoperative fentanyl consumption and pain scores (VAS) at one hour after lumbar herniated disc surgery, indicating effective pain management shortly after the procedure.

Patients receiving the ESP block did not require intraoperative opioids, suggesting that this technique may enhance overall opioid-sparing strategies during surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is Opioid-free Anesthesia Possible by Using Erector Spinae Plane Block in Spinal Surgery? Taşkaldıran, Y.[2021]

In a study of 15 patients undergoing thoracic surgery, the use of erector spinae plane blocks with ropivacaine showed a mean peak concentration (Cmax) of 2.5 mg/L, with some patients reaching potentially toxic levels, although no severe neurological symptoms were reported.

To minimize the risk of local anesthetic systemic toxicity, it is recommended to use a weight-based dosing approach, suggesting a maximum dose of 2.5 mg/kg based on ideal body weight, and reducing the initial dose to 75 mg could lower the risk of toxicity to less than 1%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Population pharmacokinetic and safety analysis of ropivacaine used for erector spinae plane blocks. Schwenk, ES., Lam, E., Abulfathi, AA., et al.[2023]

In a study of 342 patients undergoing lumbar spine surgery, ultrasound-guided erector spinae plane blocks (ESPB) showed no complications directly related to the procedure, highlighting its safety profile.

The incidence of poorly controlled pain (NRS ≥7) in the post-anesthesia care unit was low at 5%, indicating that ESPB may effectively manage postoperative pain without significant adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Procedure-Specific Complications Associated with Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spine Surgery: A Retrospective Analysis of 342 Consecutive Cases. Oezel, L., Hughes, AP., Onyekwere, I., et al.[2022]

The erector spinae plane (ESP) block is a promising technique for managing chronic thoracic pain, showing benefits such as reduced opioid use and longer time to first analgesic requirement, based on a qualitative review of four randomized controlled trials.

While the ESP block appears to be safe and effective, with some studies suggesting it can be as effective as epidural analgesia, further well-designed randomized controlled trials are necessary to fully understand its safety and efficacy compared to standard regional anesthesia techniques.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: a systematic qualitative review. De Cassai, A., Bonvicini, D., Correale, C., et al.[2022]

The erector spinae plane (ESP) block effectively distributes local anesthetic, as shown by the presence of methylene blue in multiple intercostal spaces and the paravertebral space, indicating its potential for pain management.

The exact pathway through which the anesthetic travels from the posterior to the anterior thorax remains unclear, suggesting that further research is needed to fully understand the mechanism of action of the ESP block.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: A cadaver study to determine its mechanism of action. Vidal, E., Giménez, H., Forero, M., et al.[2022]

The Erector Spinae Plane Block (ESPB) is an effective ultrasound-guided technique for managing postoperative pain, particularly in the thoracic and abdominal areas.

This study highlights the successful use of a fluoroscopic-guided ESPB specifically for lower back spinal surgery, suggesting its versatility and potential benefits in pain management for this type of procedure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fluoroscopic-guided erector spinae plane block for spine surgery. Kim, E., Alshoubi, A.[2022]

In a study of 84 patients undergoing posterior lumbar interbody fusion, preoperative bilateral erector spinae plane blocks significantly improved the quality of recovery 24 hours post-surgery, with a median score difference of 9 compared to the control group.

The erector spinae plane blocks also reduced pain scores, delayed the need for rescue analgesia, decreased morphine consumption, and lowered the incidence of postoperative nausea and vomiting, all without any reported adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bilateral Erector Spinae Plane Block for Quality of Recovery Following Posterior Lumbar Interbody Fusion: A Randomized Controlled Trial. Lin, H., Guan, J., Luo, S., et al.[2023]

The erector spinae plane block (ESPB) was successfully used to treat a 52-year-old woman with chronic radicular left arm pain in the emergency department, demonstrating its potential effectiveness for upper extremity pain management.

Using ESPB can help avoid the risks associated with opioid use and preserve motor function, making it a safer alternative to traditional pain management methods like brachial plexus blockade.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector Spinae Plane Block in the Emergency Department for Upper Extremity: A Case Report. Lee, DH., Martel, ML., Reardon, RF.[2021]

The Erector Spinae Plane (ESP) block is a safe and effective regional anesthesia technique that can provide pain relief for various surgical procedures, including breast, thoracic, and abdominal surgeries, as well as chronic pain management.

In a series of six cases, both continuous and single-shot ESP blocks demonstrated successful postoperative pain control, highlighting the versatility of this technique in different clinical scenarios.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Erector spinae plane block: Relatively new block on horizon with a wide spectrum of application - A case series. Jain, K., Jaiswal, V., Puri, A.[2020]

The erector spinae plane (ESP) block effectively spreads analgesic dye from the T1 to T11 levels in the dorsal region, indicating its potential for broad pain control in the thoracic area.

Importantly, the study found no diffusion of the contrast solution into the anterior region or paravertebral space, suggesting a targeted mechanism of action that minimizes the risk of affecting surrounding structures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Aponte, A., Sala-Blanch, X., Prats-Galino, A., et al.[2022]

Citations

1.

nature.com

nature.com/articles/s41598-025-03958-w

A randomized clinical trial of erector spinae plane block ...

The primary hypothesis of this study was that ESPB reduces the incidence of chronic pain for 3 months after posterior lumbar surgery.

2.

orthopedicreviews.openmedicalpublishing.org

orthopedicreviews.openmedicalpublishing.org/article/124769-erector-spinae-plane-block-for-chronic-lumbosacral-pain-a-case-report

Erector Spinae Plane Block for Chronic Lumbosacral Pain

Following the ESP block, the patient reported a significant reduction in his low back pain, with approximately 90% improvement in his pain ...

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10900103/

Efficacy of erector spine plane block in two different ...

ESPB significantly reduced pain intensity at rest in both surgical approaches 48 h after surgery (p < 0.05). The need for postoperative fentanyl infusion was ...

4.

sciencedirect.com

sciencedirect.com/science/article/pii/S0736467925003737

Ultrasound Guided Erector Spinae Plane Block for Pain ...

Lower NRS at 1-hour and greater reduction in NRS at 1, 3, 5, and 10-hours in ESPB group; fewer patients in ESPB group required rescue analgesia ...

5.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/37976481/

Comparison of the Low Back Pain Relief and Spread Level ...

Results: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively.

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11608537/

Impact of Erector Spinae Plane Blocks on Pain Management ...

ESPBs were associated with statistically and clinically significant reductions in 24-hour opioid consumption and LOS, without differences in NRS pain scores ...

7.

frontiersin.org

frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1330446/full

Efficacy of erector spine plane block in two different ...

ESPB significantly reduced pain intensity at rest in both surgical approaches 48 h after surgery (p < 0.05). The need for postoperative fentanyl infusion was ...

8.

painphysicianjournal.com

painphysicianjournal.com/current/pdf?article=ODAzMw%3D%3D

The Safety and Outcome of Erector Spinae Plane Block in ...

However, the safety of ESPB in patients being treated with antiplatelets and anticoagulants is based on limited clinical data, mostly from single case series.