Background and aims We report a case of continuous erector spinae plane block (ESPB) for pain relief and successful weaning of patient from mechanical ventilation with multiple bilateral rib fractures and flail segment.
Methods ESPB was performed at the level of T5 transverse process using Sonosite M Turbo 6–13 MHz 38 mm linear probe in-plane technique on both sides. 18 G touhys needle was used and once the T5 transverse process was hit using USG guidance after negative aspiration 15 ml of 0.1% ropivacaine was given as bolus and 20G (Perifix BBraun) epidural catheter was inserted around 5 ml of 0.% ropivacaine was used to hydrodissect and catheter was threaded without any resistance and the local anesthetic spread was confirmed using USG. We kept the catheter tip around 4 cm inside and the catheter was tunnelled and fixed over the skin and secured using a tight adhesive on both sides. We started an infusion of 0.1% ropivacaine with 2 mcg/ml of fentanyl at a rate of 5 ml/hr .
Results We could find loss of cold sensation of hemithorax from T1 to T9. We also assessed the pain score at rest and after cough. Numerical pain score was 0/10 at rest and 1/10 after coughing. He was actively mobilised throughout and was given thorough incentive spirometry and chest physiotherapy. Erector spinae catheter was removed on the 6th day and was observed for one more day. He was completely pain free and was discharged on the 7th day.
Conclusions Continuous ESPB is a novel, simple technique with less complication and with intense and rapid analgesia.
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