LAUSR

Erector spinae plane (ESP) block is a simple and promising regional anaesthesia technique, consisting of an ultrasound-guided parasagittal injection of local anaesthetic (LA) in the plane between the erector spinae muscle and the vertebral transverse process [1]. The ideal targets of this block are both ventral and dorsal rami of the spinal roots, with local anaesthetic spreading to the paravertebral space. Recently, ESP applications for hip analgesia have been discussed, as it seems that a lumbar ESP could act as a lumbar plexus block [2], although the pathway of LA to lumbar plexus has not been clearly described. Moreover, ESP block at the lumbar level is difficult to perform in a classic parasagittal approach, due to the greater depth of lumbar transverse processes compared with thoracic ones. For this reason, we prefer to use the easier ‘Shamrock’ approach to lumbar ESP block, previously described by De Cassai et al. [3] and we have successfully performed this technique for hip surgery analgesia. After viewing the Shamrock sign using an ultrasound curvilinear probe, the needle (100 mm Stimuplex Ultra 360, B. Braun, Germany) is inserted at the L2 level, 5 cm lateral to the midline, and then advanced in a postero-anterior direction until it contacts the transverse process. The injection point is