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Brief Review

Pain Management & Sedation

Erector spinae plane block for intractable, nonsurgical abdominal pain: a scoping review
Ashley Meyer, Campbell Belisle Haley, Eisa Razzak, Amanda Dos Santos, Kyle Dornhofer, Edmund Hsu, Soheil Saadat, John Christian Fox, Megan Guy
Clin Exp Emerg Med 2024;11(4):379-386.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.171

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Erector spinae plane block for intractable, nonsurgical abdominal pain: a scoping review
Clin Exp Emerg Med. 2024;11(4):379-386.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.171
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Erector spinae plane block for intractable, nonsurgical abdominal pain: a scoping review
Clin Exp Emerg Med. 2024;11(4):379-386.   Published online March 15, 2024
DOI: https://doi.org/10.15441/ceem.23.171
Close
Abdominal pain is one of the most common presenting chief complaints in the emergency department. Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of nonsurgical abdominal pain has not yet been characterized. Our scoping review aims to synthesize current knowledge on the safety and efficacy of ESPB in the management of patients experiencing intractable, nonsurgical abdominal pain. We searched PubMed and Scopus to evaluate the existing literature on ESPB for nonsurgical abdominal pain. A total of 14 journal articles were included: 12 case-based studies, one systematic review, and one narrative review. All cases described the successful use of ESPB in treating abdominal pain refractory to oral or intravenous analgesic medications, and no complications were reported in any cases. This scoping review provides support for the use of ESPB to manage intractable, nonsurgical abdominal pain. ESPB has demonstrated efficacy in alleviating various conditions such as functional abdominal pain, renal colic, pancreatitis, herpetic pain, and cancer-related pain. Theoretical risks such as pneumothorax, bleeding, and infection are possible, although the studies reviewed did not report such complications.

Citations

Citations to this article as recorded by  Crossref logo
  • Comparison of quadro-iliac plane block and erector spinae plane block for postoperative analgesia management after single level lumbar discectomy surgery: a randomized, double-blind, controlled, prospective, multicenter study
    Engin İhsan Turan, Büşra Otlu Bıyıkoğlu, Volkan Özen, Selçuk Alver, Tarık Umutoğlu, Oğuzhan Cücü, Serdar Çevik, Bahadır Çiftçi, Ayça Sultan Şahin
    Journal of Anesthesia.2026; 40(1): 84.     CrossRef
  • A Pilot Study Evaluating Erector Spinae Block Versus Saline For Emergency Department Patients With Ureterolithiasis
    Michael Secko, Daniel D. Singer, Gilbert Tetteh, Matthew Vitale, Benjamin Fombonne, Kristopher Bianconi, Rafael Fernandes, Andrea Gowie, Adam J. Singer
    The Journal of Emergency Medicine.2026; 83: 1.     CrossRef
  • Efficacy of an erector spinae plane block for renal colic: a systematic review and meta-analysis
    Bart Gerard Jan Candel, Laura N Visser, Ewoud ter Avest, Milan L Ridderikhof, Bas De Groot, Rens Jacobs, Saskia Weltings, Rolf H H Groenwold, Leti van Bodegom, Wilbert B van den Hout, Marleen Kemper, Markus W Hollmann
    Emergency Medicine Journal.2025; 42(5): 317.     CrossRef
  • Treatment of gastritis and gastroparesis symptoms with erector spinae plane block in the emergency department
    Richard J. Gawel, Michael Gottlieb, Frances S. Shofer, Michael Shalaby
    The American Journal of Emergency Medicine.2025; 96: 298.e1.     CrossRef
  • The evolving role of truncal fascial plane blocks in non-surgical pain therapy: a narrative review
    Yi Gu, Yifan Qin, Jin Wu
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Erector Spinae plane block for analgesia in patients with acute pancreatitis: a scoping review
    Karim Sadik, Khang Duy Ricky Le, William Keenan
    Next Research.2025; 2(4): 100874.     CrossRef
  • Ultrasound-Guided Erector Spinae Plane Block in the Emergency Department: A Treatment for Intractable Sciatica
    Carlos A Gonzalez-Cobos, Miguel J Rosa Carrasquillo, Miguel F Agrait Gonzalez
    Cureus.2024;[Epub]     CrossRef
  • 8,548 View
  • 196 Download
  • 7 Web of Science
  • 7 Crossref

Case Report

Procedures

Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?
Santi Di Pietro, Benedetta Mascia, Giuliano Lo Bianco, Stefano Perlini, Giorgio Antonio Iotti
Clin Exp Emerg Med 2020;7(1):67-70.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.18.089

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Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?
Clin Exp Emerg Med. 2020;7(1):67-70.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.18.089
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Anterior cutaneous nerve block for analgesia in anterior chest trauma: is the parasternal approach necessary?
Clin Exp Emerg Med. 2020;7(1):67-70.   Published online March 31, 2020
DOI: https://doi.org/10.15441/ceem.18.089
Close
In recent years, several techniques of regional anesthesia have been proposed to provide analgesia to the anterior thoracic cage; notably, most of these techniques require a parasternal approach. However, in this context, the potential role of a more common and well-established technique, namely the modified pectoral nerve block (known as PECS II block), has been poorly investigated. Here, we describe a case involving a patient with bilateral anterolateral multiple rib fractures associated with sternum fracture, who was successfully treated using bilateral PECS II blocks. Our experience indicates that the PECS II block can provide excellent analgesia in cases involving anterior rib and sternum fractures. Because it is easier to perform and may be safer than other parasternal techniques, the PECS II block should be considered when providing analgesia for traumatic injuries of the anterior thorax.

Citations

Citations to this article as recorded by  Crossref logo
  • Use of fascial plane blocks for traumatic rib fractures: a scoping review
    Ahtsham U Niazi, Max Solish, Aneurin Moorthy, Faizan Niazi, Antonio Hermes Abate, Catherine Devion, Stephen Choi
    Regional Anesthesia & Pain Medicine.2026; 51(4): 414.     CrossRef
  • Differences in opioid analgesic practices between emergency medicine specialists and general practitioners: a cross-sectional study
    Mustafa Öcal
    Internal and Emergency Medicine.2026; 21(2): 549.     CrossRef
  • Ultrasound-Guided Regional Anesthesia in a Resource-Limited Hospital: Prospective Pilot Study of a Hybrid Training Program
    Jakob E Gamboa, Inge Tamm-Daniels, Roland Flores, Nancy G Sarat Diaz, Mario A Villasenor, Mitchell A Gist, Aidan B Hoie, Christopher Kurinec, Colby G Simmons
    JMIR Medical Education.2026; 12: e84181.     CrossRef
  • Efficacy and Safety of Serratus Anterior Plane Block and Erector Spinae Plane Block for Rib Fracture Pain
    Bing-Hua Lin, Hui-Min Huang, Sheng-Feng Lin
    The Clinical Journal of Pain.2026;[Epub]     CrossRef
  • When Regional Anesthesia is Mistaken for Pain Medicine: The Importance of Etiology-Driven Interventional Pain Management
    Giuliano Lo Bianco, Laura Demartini, Marco Mercieri, Michael Schatman
    Journal of Pain Research.2026; Volume 19: 1.     CrossRef
  • Evolution of simulation-based training in Italian emergency medicine residency programs: results from a national longitudinal survey (2022–2024)
    Giulia Mormando, Michela Cascio, Monica Di Cristoforo, Gianpiero Zaccaria, Bruno Barcella, Valentina Angeli, Sofia Pons, Pier Luigi Ingrassia
    Emergency Care Journal.2026;[Epub]     CrossRef
  • Evaluation of a rib fracture management pathway in an Australian tertiary trauma hospital
    Craig Morrison, Kiara Song, Tim Soon Cheok, Sean Liew, Rohen Skiba, Greg Rice, Ruurd L Jaarsma, Hidde M Kroon, D-Yin Lin
    Journal of International Medical Research.2026;[Epub]     CrossRef
  • Acute pain management of rib fractures: a narrative review
    Thomas Ulrich Bresgen, Francesco Salinaro, Bruno Barcella, Stefano Perlini, Ilenia Mascherona, Santi Di Pietro
    Injury.2025; 56(12): 112857.     CrossRef
  • Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain
    Giuliano Lo Bianco, Andrea Tinnirello, Alfonso Papa, Vito Torrano, Gianluca Russo, Agnes Stogicza, Sebastiano Mercadante, Andrea Cortegiani, Silvia Mazzoleni, Michael E Schatman
    Journal of Pain Research.2023; Volume 16: 1637.     CrossRef
  • Current Review of Analgesia and Regional Anesthesia Practices for Rib Fracture and Chest Wall Trauma
    Paul D. Piennette, Sara Elizabeth Morris, Theresa Northern
    Current Anesthesiology Reports.2022; 12(3): 407.     CrossRef
  • Regional Anesthesia for Trauma in the Emergency Department
    Nadia Hernandez, Johanna B. de Haan
    Current Anesthesiology Reports.2022; 12(2): 240.     CrossRef
  • Bilateral PECS II Block is Associated with Decreased Opioid Consumption and Reduced Pain Scores for up to 24 hours After Minimally Invasive Repair of Pectus Excavatum (Nuss Procedure): A Retrospective Analysis
    Gokhan Sertcakacilar, Selcuk Kose
    Journal of Cardiothoracic and Vascular Anesthesia.2022; 36(10): 3833.     CrossRef
  • 8,207 View
  • 142 Download
  • 12 Web of Science
  • 12 Crossref
Original Articles

Pain Management & Sedation

Factors affecting determination of the optimal ketamine dose for pediatric sedation
Ji Young Min, Jeong-Rim Lee, Hyun IL Kim, Hyo Jin Byon
Clin Exp Emerg Med 2019;6(2):119-124.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.012

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Factors affecting determination of the optimal ketamine dose for pediatric sedation
Clin Exp Emerg Med. 2019;6(2):119-124.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.012
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Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Factors affecting determination of the optimal ketamine dose for pediatric sedation
Clin Exp Emerg Med. 2019;6(2):119-124.   Published online June 28, 2019
DOI: https://doi.org/10.15441/ceem.18.012
Close
Objective
Children are sedated before undergoing diagnostic imaging tests in emergency medicine or pediatric sedation anesthesia units. The aim of this study was to identify variables potentially affecting the dose of ketamine required for induction of sedation in pediatric patients undergoing diagnostic imaging.
Methods
This retrospective study included children aged 0 to 18 years who underwent sedation with ketamine for computed tomography or magnetic resonance imaging in the pediatric sedation anesthesia unit of a tertiary medical center between January 2011 and August 2016. The children’s hemodynamic status and depth of sedation were monitored during the examination. We recorded data on demographics, categories of imaging tests, ketamine doses administered, adverse events, respiratory interventions, and duration of sedation. Data for patients who experienced adverse events were excluded.
Results
Sixty-six patients were included in the final analysis. Univariate linear regression analysis revealed that patient age, height, and body surface area (BSA) affected the sedative dose of ketamine administered. These three variables showed multicollinearity in multivariate linear regression analysis and were analyzed in three separate models. The model with the highest adjusted R-squared value suggested the following equation for determination of the dose of ketamine required to induce sedation: ketamine dose (mg)=-1.62+0.7×age (months)+36.36×BSA (m2).
Conclusion
Variables such as age and BSA should be considered when estimating the dose of ketamine required for induction of sedation in pediatric patients.

Citations

Citations to this article as recorded by  Crossref logo
  • Optimizing ketamine dosing strategies across diverse clinical applications: a comprehensive review
    Ahmed M. Kedwany, Reem Sayad, Nada S. Jibril, Eslam A. Hawash, Amna M. Anis, Nardein John Wadie Danial, Ahmed Saad Elsaeidy, Neveen A. Kohaf
    Annals of Medicine & Surgery.2025; 87(9): 5678.     CrossRef
  • Role of Low-dose Intramuscular Ketamine in Vascular Access in Pediatric Patients with Sedation Anesthesia in Magnetic Resonance Imaging
    Naime Yalçın, Nurdan Yılmaz, Kadir Arslan, Ayça Sultan Şahin, Abdurrahim Derbent, Ziya Salihoğlu
    Bagcilar Medical Bulletin.2023; 9(1): 21.     CrossRef
  • Easy sedation anesthesia guide for non-anesthetic medical personnel
    Too Jae Min
    Journal of the Korean Medical Association.2020; 63(1): 36.     CrossRef
  • 11,223 View
  • 126 Download
  • 2 Web of Science
  • 3 Crossref

Procedures | Imaging

Ultrasound-guided regional anesthesia for the pain management of elderly patients with hip fractures in the emergency department
Hee Kyung Lee, Bo Seung Kang, Chang Sun Kim, Hyuk Joong Choi
Clin Exp Emerg Med 2014;1(1):49-55.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.008

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Ultrasound-guided regional anesthesia for the pain management of elderly patients with hip fractures in the emergency department
Clin Exp Emerg Med. 2014;1(1):49-55.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.008
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Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
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Ultrasound-guided regional anesthesia for the pain management of elderly patients with hip fractures in the emergency department
Clin Exp Emerg Med. 2014;1(1):49-55.   Published online September 30, 2014
DOI: https://doi.org/10.15441/ceem.14.008
Close
Objective

We examined the pain-relieving effect of ultrasound-guided regional anesthesia performed by emergency physicians on elderly hip fracture patients.

 Methods

This study is a prospective, non-randomized, case-control study. The subjects were patients older than 65 years who visited the emergency department with a hip fracture. After we obtained informed consent, two emergency physicians performed an ultrasound-guided three-in-one femoral block using 20 mL of 0.5% bupivacaine. The pain score was measured just before regional anesthesia, and 0.25, 0.5, 1, 2, 3, and 4 hours after the procedure. Another group of patients was given multiple doses of morphine to control the pain. We compared the change in pain score and the development of adverse reactions between the two groups.

 Results

A total of 47 patients were enrolled in this study, of which 25 were given regional anesthesia. Successful pain control (pain score<4) was significantly higher in the regional anesthesia group (96.0% vs. 40.9%; P<0.001). The decrease in pain score was significantly higher in the regional anesthesia group (7 [interquartile range, 6 to 7] vs. 4 [interquartile range, 3 to 5]; P< 0.001). The only adverse reaction observed was mild nausea in 4 patients (1 out of 25 from the regional anesthesia group and 3 out of 22 from the morphine group).

 Conclusion

Ultrasound-guided regional anesthesia administered by emergency physicians treating elderly hip fracture patients provided faster pain relief and a larger decrease in pain than conventional intravenous injections of morphine.

Citations

Citations to this article as recorded by  Crossref logo
  • Rapid Proficiency in Femoral and Popliteal Nerve Identification Is Achievable After a Brief Educational Intervention
    Ashley Grant, Colin Sullivan, Brandon Buchel, Charlotte Derr
    Cureus.2025;[Epub]     CrossRef
  • Complications of Ultrasound-Guided Peripheral Nerve Blocks in the Emergency Department: A Systematic Review and Meta-Analysis
    Joyce Hanyue Gu, Adrian Cotarelo, Mark Samarneh
    The Journal of Emergency Medicine.2025; 75: 256.     CrossRef
  • Precision and safety advantages of ultrasound-guided nerve blocks in geriatric anesthesia: current status and future prospects
    Xiao-yin Lin, Ya-mei Yang, Yang Liu, Qing-qing Dang, Kan Zhang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Unique considerations in regional anesthesia for emergency department and non-or procedures
    Elizabeth A. Scholzen, John B. Silva, Kristopher M. Schroeder
    International Anesthesiology Clinics.2024; 62(1): 43.     CrossRef
  • Serratus Anterior Plane Block Remote Learning Curriculum
    Gabriel Weingart, Di Coneybeare
    MedEdPORTAL.2024;[Epub]     CrossRef
  • Comparative study lumbar plexus block and lumbar erector spinae plane block for postoperative pain relief after proximal femoral nail for proximal femoral fractures
    Sandeep Diwan, Abhishek Lonikar, Himaunshu Dongre, Parag Sancheti, Abhijit S. Nair, Suhrud Panchawagh
    Saudi Journal of Anaesthesia.2023; 17(2): 147.     CrossRef
  • The impact of loco-regional anaesthesia on postoperative opioid use in elderly hip fracture patients: an observational study
    Gioia Häusler, Puck C. R. van der Vet, Frank J. P. Beeres, Thomas Kaufman, Jip Q. Kusen, Beate Poblete
    European Journal of Trauma and Emergency Surgery.2022; 48(4): 2943.     CrossRef
  • An integrative comparative study between ultrasound-guided regional anesthesia versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: A systematic review and meta-analysis
    Hany A. Zaki, Haris Iftikhar, Nabil Shallik, Amr Elmoheen, Khalid Bashir, Eman E. Shaban, Aftab Mohammad Azad
    Heliyon.2022; 8(12): e12413.     CrossRef
  • Sustained Release of Levobupivacaine, Lidocaine, and Acemetacin from Electrosprayed Microparticles: In Vitro and In Vivo Studies
    Jian-Ming Chen, Kuan-Chieh Liu, Wen-Ling Yeh, Jin-Chung Chen, Shih-Jung Liu
    International Journal of Molecular Sciences.2020; 21(3): 1093.     CrossRef
  • Preoperative Pain Management of Patients with Hip Fractures: Blind Fascia Iliaca Compartment Block Compared to Ultrasound Guided Femoral Nerve Block—A Randomized Controlled Trial
    Johanne Bangshoej, Thomas Thougaard, Hans Fjeldsøe-Nielsen, Sandra Viggers
    Open Journal of Anesthesiology.2020; 10(11): 371.     CrossRef
  • A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos
    Changsun Kim, Hyunmin Cha, Bo Seung Kang, Hyuk Joong Choi, Tae Ho Lim, Jaehoon Oh
    Journal of Digital Imaging.2016; 29(3): 347.     CrossRef
  • Identification of teaching priorities for ultrasound-guided regional anesthesia as first-line pain management in a swiss university emergency department
    Eckehart Schöll, Dieter Kolleth, Gilbert Krähenbühl, Christian H Nickel, Roland Bingisser
    Emergency Medicine and Health Care.2016; 4(1): 2.     CrossRef
  • The Use of Clinician-Performed Ultrasonography to Determine the Treatment Method for Suspected Paediatric Appendicitis
    C Kim, B Kang, Jb Park, Yr Ha
    Hong Kong Journal of Emergency Medicine.2015; 22(1): 31.     CrossRef
  • 16,337 View
  • 154 Download
  • 10 Web of Science
  • 13 Crossref
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CEEM : Clinical and Experimental Emergency Medicine