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ESRA19-0584 Awake thoracic spine surgery under bilateral multiple midpoint transverse process to pleura (MTP) blocks: a case report
  1. A Kilicaslan1 and
  2. BK Kacira2
  1. 1Necmettin Erbakan University, Meram School of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
  2. 2Necmettin Erbakan University, Meram School of Medicine, Department of Orthopaedic Surgery, Konya, Turkey


Background and aims Although general anesthesia is almost the only technique in thoracic spine surgery, it carries high risks of ventilator dependency, unstable hemodynamics, postoperative pain, with increased morbidity and mortality. We aimed to present a case where we applied the bilateral multiple ultrasonography guided MTP blocks for awake thoracic spine surgery.

Methods A 62-year-old male with a history of hypertension and chronic respiratory disease was planned for surgical treatment of osteoporotic vertebral (T6) collapse fracture with severe pain (VAS >8). A decision was made to perform preoperative MTP blocks to provide some immediate relief during preparation of patient. After identification of the midpoint between the transverse process and pleura, MTP blocks were performed bilaterally at T3, T5 and T7 using parasagittal scan and in-plane needle insertion caudad to cephalad with 55 ml 0,25% bupivacaine and 8 mg of dexamethasone (9 ml for each level).

Results After 30 minutes, the patient reported that his pain had diminished significantly. Using a pinprick test with a 22-G needle, we determined in the T2-T8 dermatomes that were completely anesthetized. Considering the patient‘s prior history and comorbidities, we attempted to perform surgery under regional anesthesia. After all preparations (laryngeal mask airway, videolaryngoscope etc.) for ventilation and possible emergencies in the prone position, posterior transpedicular screw fixation between T4-T8 levels was performed uneventfully, without any additional supplementation of local anesthetic. The patient was cooperative with moderate sedation and oxygen was administered by face mask.

Conclusions We report the first use of bilateral multiple MTP blocks which provided excellent and complete surgical anesthesia for thoracic spine surgery.

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