In performing regional anesthesia, I prioritize Safety over Efficacy over Efficiency (although I of course aim to achieve all 3). The ESP (Erector Spinae Plane) block is a very safe technique if performed properly. LAST (local anesthetic systemic toxicity) is the most likely adverse effect, but even that is rare and usually minor. Current evidence indicates epinephrine should always be added to the local anesthetic solution to optimize the pharmacokinetics of absorption.

(Excerpted from a lecture delivered at the 49th Congreso Chileno de Anestesiologia in Nov 2023)