Bilevel-Bilateral Sacral Erector Spinae Plane Block for Chronic Pain Management: A Case Report and Short Literature Review

Erector spinae plane block (ESPB), one of the popular regional anesthesia techniques in recent years, has first been used for upper thoracic neuropathic pain. Later, it has been used in many different indications for both acute and chronic pain treatment at different lower thoracic and lumbar levels. Our limited experience demonstrates that bilevel bilateral sacral ESPB is an easy and effective method in the treatment of perianal chronic intermittent pain. However, many issues, such as the application site, the volume of local anesthetics and the sensory blockade, still remain being investigated. Due to the lack of clinical research, our review is currently unable to support the evidence and routine use of sacral ESPB. We consider that anatomical radiological and  clinical studies are needed to elucidate the efficacy and mechanism of action of sacral ESPB