JEM April 2026 Podcast Summary

All right.

Our first article this month is entitled "A Pilot Study Evaluating Erector Spinae Plane Block versus Saline for Emergency Department Patients with Urethral Lithiasis." The author is Dr.

Michael Seco from Stony Brook, New York.

So why is this important? Well, we recently discussed the erector spinae plane block, or ESPBs, on our podcast for a number of indications.

This pilot study in particular addressed this block for a common pathology we see in the ED, namely renal stones.

So common treatments for pain due to renal colic include NSAIDs, alpha blockers like tamsulosin, and opioids, which of course have the undesirable adverse effects and addiction potential.

So as a reminder for those of you who did not catch our January episode, an erector spinae plane block is a type of regional anesthesia involving an injection in the fascial plane between the erector spinae muscles and the transverse process of the vertebra.

If done properly, it can block the nerves that control visceral pain, such as in a patient with renal colic.

So there's been a lot of data on the use of erector spinae plane blocks in the ED in the setting of patients with rib fractures.

But the authors of this study note that there's only limited literature regarding the use of these blocks on patients with renal colic.

So the objective of this study was to determine the feasibility of a randomized control trial comparing the erector spinae plane block with a local anesthetic to a normal saline or sham arm in patients with pain due to renal stones.

And they hypothesized that those who received the anesthetic would have better pain control.

So what were the methods? Well, this is a single-center prospective single-blinded study, so not an RCT yet, but this is a pilot study, and it was done over a two-year period at one urban academic medical center.

The population was a convenient sample of adults who presented to the ED.

And so to be included, they had to have presence of renal colic with evidence of a ureteral stone, either on CT scan or ultrasound, and had to have an initial pain score of greater than or equal to four out of ten.

Important exclusion criteria included patients with prior spinal surgery, pregnancy, hemodynamically unstable patients, patients with history of MI, cirrhosis, ESRD, lung trauma or lung surgery, or recent epidural injection in the prior six months.

Okay, so for the protocol, patients randomized either to group A, who received a twenty-milliliter injection of zero point five percent ropivacaine, or group B, who got a twenty-milliliter injection of normal saline.

So erector spinae plane blocks were done in both groups with one or the other of the drugs and were performed by one of six emergency medicine physicians who either completed or were in training for the focused practice designation in advanced emergency medicine ultrasound.

So two different ultrasound machines were used, and providers could select whether to use the linear probe or curvilinear transducer for their ultrasound-guided injections.

However, all injections were done with the patient in the seated position, targeting the transverse processes at the T seven to T eight level, corresponding with the inferior tip of the scapula.

And all patients were placed on the cardiac monitor and pulse ox to monitor for signs of pneumothorax or local anesthetic systemic toxicity.

So patients in both arms also received the standard of care treatments for renal colic, with rescue analgesia given at least thirty minutes after the injection.

So the primary outcome was differences in pain scores between the groups at set time points between zero minutes and one hour after the injection.

Secondary outcomes included total morphine equivalents given to the patients post-block, success rate of the block based on provider opinion, and urological procedures done within thirty days.

Okay, so what were the results? Well, there were twenty-four patients enrolled with twelve in each arm.