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Early experiences with the use of continuous erector spinae plane blockade for the provision of perioperative analgesia for pediatric liver transplant recipients
  1. Robert P Moore1,
  2. Chyong-jy Joyce Liu2,
  3. Preeta George1,
  4. Timothy P Welch1,
  5. Jacob D AuBuchon1,
  6. York Jiao1 and
  7. Julie K Drobish1
  1. 1 Department of Anesthesiology – Division of Pediatric Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  2. 2 Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, Texas, USA
  1. Correspondence to Dr Robert P Moore, Anesthesiology - Div of Pediatric Anesthesiology, Washington University in Saint Louis School of Medicine, Saint Louis, MO 63110, USA; robertpmoore{at}


Objective Pediatric liver transplantation presents a number of anesthetic challenges, especially in providing adequate perioperative analgesia. In an effort to reduce opioid consumption and improve functional outcomes following pediatric liver transplantation, we have instituted a novel analgesia protocol centered on the provision of continuous regional analgesia with erector spinae plane (ESP) blockade.

Cases We describe preincisional bilateral ESP catheter placement in two pediatric patients undergoing orthotopic liver transplantation. The first case was a 12-year-old boy with maple syrup urine disease undergoing initial transplantation and the second case was an 8-year-old boy who underwent an 11 hours complex redo liver transplant in the setting of glycogen storage disease type 1A requiring initial liver transplant in 2014. The 8-year-old boy presented to the operating suite with acute Budd-Chiari syndrome with comorbid ascites and a large right pleural effusion. In both cases, ESP blockade resulted in good analgesia, markedly reduced intraoperative and postoperative opioid consumption as compared with institutional data and published rates of consumption and was associated with rapid return of bowel function.

Conclusions These early experiences suggest a role for continuous ESP blockade to improve analgesia and potentially change the paradigm of treatment in this fragile patient population. The technique should be considered in similar interventions. Further study will be undertaken to validate our observation.

  • pediatric anesthesia
  • regional anesthesia
  • pain management

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  • Contributors RPM, PG, JKD and CJL made significant contributions to the conception, design and drafting of the work. JDA, TPW and YJ were involved in drafting and revising the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.