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 smoothly threaded 10 cm in the cephalad direction (estimated to reach T2 via surface landmark) and then injected with 20 mL 0.5% ropivacaine. Intraoperatively, the patient received ketamine 30 mg, methadone 5 mg, fentanyl 100 μg, acetaminophen 1000 mg, and ketorolac 30 mg. The ESPB catheter was programmed with a 10 mL 0.2% ropivacaine autobolus every 60 min plus a patient-demand bolus of 5 mL every 30