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P340 Vertebral compression fracture as a potential factor for epidural spread during lumbar erector spinae plane block: a case report
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P340 Vertebral compression fracture as a potential factor for epidural spread during lumbar erector spinae plane block: a case report
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Journal Article
P340 Vertebral compression fracture as a potential factor for epidural spread during lumbar erector spinae plane block: a case report
2025
Overview
Application for ESRA Abstract Prizes:Background and AimsErector Spinae Plane (ESP) blocks are popular for pain management due to their safety profile. While cadaveric studies indicate potential ventral injectate spread, clinically significant epidural blockade remains exceptionally rare. This report aims to describe an unusual case of extensive epidural spread following a lumbar ESP block, highlighting the potential contributing role of a vertebral compression fracture.MethodsA 73-year-old male with an LVAD and osteoporosis presented with new lower back pain from a subacute L2 vertebral compression fracture. A bilateral lumbar L2 ESP block was performed using 20 mL of 0.25% bupivacaine per side (patient weight 88 kg). Immediate post-procedure assessment revealed significant bilateral lower extremity motor paralysis and sensory loss, consistent with extensive epidural spread.ResultsThe motor and sensory blockade fully resolved within hours as the local anesthetic wore off. We hypothesize that the L2 compression fracture, combined with the patient‘s osteoporosis, chronic kidney disease, peripheral edema, and hypoalbuminemia, may have disrupted fascial planes or altered tissue permeability, creating a pathway for unintended neuraxial spread.Abstract P340 Figure 1Subacute L2 vertebral compression fracture[Image Omitted. See PDF.]ConclusionsThis case suggests that vertebral compression fractures may represent a potential risk factor for epidural spread during lumbar ESP blocks. Clinicians should exercise vigilance, conduct thorough pre-procedure assessment for spinal pathologies, and consider alternative injection levels to enhance safety, particularly in medically complex patients.
Publisher
BMJ Publishing Group LTD
Subject
