Background and aims Open nephrectomy is associated with severe pain and pain-derived morbidity. There are several options for postoperative pain management, each with drawbacks. Since its description in 2016,1erector spinae plane block (ESPB) has been deemed as a safe and effective regional technique. We present one of the few reports of a paediatric open nephrectomy, managed with the novel ESPB.
Methods A 1-year-old male, 9,6 kg, ASA I, diagnosed with a left Wilms tumour, was proposed for a total open nephrectomy. Informed consent was obtained. After induction of general anaesthesia and intubation, the patient was positioned in lateral decubitus. A high-frequency linear ultrasound probe was placed longitudinally on the left side, parasagittal to the level of T7-9. Following identification of the erector spinae muscle and transverse process of T8 vertebra, 0,5 ml/kg of ropivacaine 0,2% was injected unilaterally, deep to the erector spinae muscle, with an in-plane needle technique. The cranio-caudal spread of local anaesthetic was tracked to T6-10 level. The intraoperative period was uneventful and multimodal postoperative analgesia was maintained with acetaminophen and metamizole.
Results The follow-up on the surgical ward denoted a maximum FLACC score of 2 during the first 24h and of 1 thereafter, until discharge. No rescue analgesia was needed. Thereby, we recognize ESPB as a valuable option for open nephrectomy paediatric cases.
Conclusions The current report adds to the scarce body of literature regarding ESPB in infants. Moreover, our results support ESPB as a valid pain management alternative for open nephrectomy in this population.
Reg Anesth Pain Med 2016. DOI:10.1097/AAP.0000000000000451.
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