Ultrasound images for ESP block showing ribs and transverse processes
Ultrasound images for ESP block showing ribs and transverse processes
It is important to identify the tip of the transverse process (TP) when performing ESP block. With the transducer in a parasagittal orientation, scan from lateral to medial, looking for the transition from rib to TP. Panel A shows ribs, which are rounded structures with pleura visible beneath and between the ribs. Panel B shows the TPs, which appear flatter than the ribs and without pleura visible. At the point of transition from rib to TP (ie, the costo-transverse angle), the TP is more superficial than the rib.