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To the Editor, There is growing literature suggesting the successful use of a high-thoracic erector spinae plane block (ESPB) for upper extremity analgesia. 1-3 We present two novel observations (with patient consent) in which an ESPB was used as a motor-sparing alternative to the interscalene block for proximal humerus surgery and total shoulder replacement, respectively.

The first observation was a 21-yr-old woman with type-I diabetes and recurrent chondroblastoma in her proximal humerus, who presented for intralesional proximal humerus surgery through a posterior approach. To facilitate a postoperative motor examination, the avoidance of motor blockade was requested by the surgeon. An ultrasound-guided ESPB catheter (Flexblock, Teleflex, Morrisville, NC, USA) was placed using an inplane approach at the T5 level. After the fascial plane was hydro-dissected using 25 mL of saline, the catheter was …