Erector spinae plane block: bone, muscle, then flood the plane

Question 1Where does the needle tip sit in an erector spinae plane block?

1. aBetween two ribs, through the pleura
2. bOn the spinous process in the midline
3. cInside erector spinae muscle
4. dOn the transverse process, deep to erector spinae

Question 2How do you tell a transverse process from a rib on ultrasound?

1. aRibs are always deeper
2. bThe transverse process is flat-topped and square, while ribs are rounded with pleura between them
3. cRibs have no acoustic shadow
4. dThe transverse process moves with breathing

Question 3Why is the erector spinae plane block considered lower risk for pneumothorax?

1. aIt needs no needle
2. bThe needle targets bone well away from the pleura
3. cIt is performed in front of the chest
4. dThe pleura is absent at that level

Question 4What does correct spread look like?

1. aFluid in the skin only
2. bA long strip of fluid lifting erector spinae off the bone and spreading up and down
3. cA round swelling inside the muscle
4. dFluid between the ribs below the pleura

Question 5Which statement about the evidence for this block in rib fractures is accurate?

1. aIt is growing but mixed, and the extent of the block varies between patients
2. bIt always blocks the whole chest wall on both sides
3. cIt has no evidence of any benefit
4. dIt is proven to remove the need for any other analgesia