ESP Block (Peds)

Last updated: February 9, 2026

For

Thoracic surgeries

Needle

21G 100mm

Local

0.2 ropivacaine 20 mL with 50 clonidine

Target

Situate patient in lateral positioning. Find Rib and then count down to the appropriate rib space at level of thoracic incision. Going lateral from spine will result in more rib. Head medial to bring the transverse process into view (will “square” up the rib). Enter the needle from head facing feet, insert until bone is contacted. Then pull back slightly, as that is where the erector spinae muscle is and where injection should lift the muscle off the plane.

Tricks

Keep probe and needle parallel to ground and spine.