The Sacral Erector Spinae Plane Block: A Narrative Review
Bibliographic record
Abstract
INTRODUCTION: The sacral erector spinae plane (S-ESP) block is a recently described regional anesthesia technique that targets sacral dermatomes. First reported in 2019, it has been increasingly explored as a potential option for perioperative analgesia in surgeries involving the sacral, perineal, and pelvic regions. This review aims to summarize and critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block, outlining its mechanisms of action, approaches, efficacy, and safety while identifying research gaps and future directions. METHODS: We performed a narrative review integrating anatomical descriptions, sonographic techniques, and available randomized controlled trials (RCTs) evaluating the clinical efficacy of the S-ESP block. A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Ovid (Medline) from inception to July 21, 2025, without language or date restrictions. Full-text RCTs investigating ultrasound-guided S-ESP blocks for perioperative analgesia were reviewed and summarized. RESULTS: Fourteen RCTs (published 2023-2025) were included, conducted predominantly in Turkey, India, and Egypt, spanning pediatric (6 months to 12 years) and adult populations undergoing circumcision, hypospadias repair, hemorrhoidectomy, pilonidal sinus surgery, transurethral resection of prostate, lumbar discectomy, and total hip arthroplasty. Most pediatric trials compared midline S-ESP with caudal or penile blocks, generally demonstrating a longer time to first rescue analgesia and reduced postoperative analgesic consumption, although one study reported a superior duration with caudal block. In adults, the S-ESP block consistently reduced pain scores and opioid requirements. CONCLUSIONS: Current evidence suggests that both midline and paramedian S-ESP techniques are technically feasible, appear safe in the short term, and provide clinically relevant postoperative analgesia in selected pediatric urogenital, adult anorectal, and orthopedic surgeries. However, heterogeneity in techniques, small single-center samples, and a narrow range of indications limit its generalizability. Large, multicenter RCTs with standardized protocols are needed to clarify the optimal approaches, dosing strategies, and comparative role of S-ESP block versus established neuraxial and peripheral techniques.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".