Background and aims Ivor Lewis oesophagectomy requires abdominal and right thoracic dissection with an intra-thoracic anastomosis. Traditionally, analgesia for these surgeries included paracetamol and opioids via patient-controlled analgesia (PCA) pumps.
Poor pain control leads to respiratory complications, deconditioning secondary to inability to engage with physiotherapy and patient dissatisfaction. Excessive opioid consumption is associated with increased incidence of ileus and significant nausea/vomiting.
Erector spinae plane block (ESP) has been shown to be effective in multi-level rib fractures and thoracic surgeries. We postulated that ESP potentially decreases reliance on opioids in Ivor Lewis oesophagectomy.
Methods We describe a case of bilateral ESP blocks as an opioid-sparing technique for an Ivor Lewis oesophagectomy in a 60-year-old gentleman with hyperlipidaemia and oesophageal carcinoma.
Bilateral single-shot ESP was done at T6 with 25 ml boluses of Ropivacaine 0.3% + adrenaline 1:400k given to each side. Induction was with propofol, lignocaine, fentanyl and atracurium. Anaesthesia was maintained with desflurane and a titrated remifentanil infusion (total dose 1.24 mg). Surgical duration was 5.5 hr. Paracetamol 1 g and morphine 10 mg were given 1 hr prior to extubation.
Post-operative analgesia: Paracetamol 1 g Q6H and PCA fentanyl.
Results PCA was taken off on postoperative day (POD) 4. Paracetamol was continued throughout admission. No opioids were required after POD 4.
Conclusions ESP can be done as part of opioid-sparing multimodal analgesia in Ivor Lewis oesophagectomy. It is a relatively safe block which can be considered in patients in whom high dose opioids can be detrimental. The next step could be to evaluate the efficacy of continuous ESP in an RCT to determine if there is any real clinical benefit.
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