An echogenic 21 gauge 10 cm needle was introduced in caudo-cephalic orientation utilizing the in-plane approach and traversing through trapezius, rhomboid, and erector spinae muscles till reaching the transverse process then slightly withdrawn and hydrodissection was done by 3 mL of saline 0.9% to verify the accurate implantation of the block needle tip between the erector spinae muscle and the transverse process (the erector spinae plane). Incremental LA injection was verified through US observation for the upward displacement and lifting of erector spinae muscle from the transverse process with craniocaudal spread of the LA in the targeted plane. The LA increments were one ml every 5 seconds with intermittent aspiration every 5 mL to avoid intravascular injection.

An echogenic 21 gauge 10 cm needle was introduced in caudo-cephalic orientation utilizing the in-plane approach and traversing through trapezius, rhomboid, and erector spinae muscles till reaching the transverse process then slightly withdrawn and hydrodissection was done by 3 mL of saline 0.9% to verify the accurate implantation of the block needle tip between the erector spinae muscle and the transverse process (the erector spinae plane). Incremental LA injection was verified through US observation for the upward displacement and lifting of erector spinae muscle from the transverse process with craniocaudal spread of the LA in the targeted plane. The LA increments were one ml every 5 seconds with intermittent aspiration every 5 mL to avoid intravascular injection.