Background and aims Ultrasound-guided erector spinae plane (ESP) block is a regional anesthetic procedure originally described for thoracic analgesia when performed at the T5 transverse process.1 However, if performed at lower thoracic levels, the ESP block can provide abdominal analgesia. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia.2
We aim to present the result of the analgesic efficacy of continuous ultrasound-guided ESP block at T8 level for a sub-costal incision for an open nephrectomy.
Methods 65-year-old woman presented for laparoscopic radical nephrectomy (giant tumor: 17×12 cm). A balanced general anesthesia was done. Due to laparoscopic technical difficulties, surgery was converted, requiring an antero-posterior subcostal incision (30 cm length). Just before the awakening, an ultrasound-guided unilateral left continuous ESP block was performed at the level of T8.25 millilitres of ropivacaine 0,375% were administered.
The multimodal approach for postoperative analgesia was: programmed intermittent mandatory boluses through the ESP catheter of ropivacaine 0,2% 8 ml/h + paracetamol 1 g 8/8h + ketorolac 30 mg 12/12h.Rescue analgesia with tramadol 100 mg.
Results During the 4 days of follow-up by the acute pain unit, there was no need for rescue analgesia. The maximum pain reported was 2 (numeric scale). The ESP catheter was removed on the fourth day.
Conclusions Pain after subcostal incision presents a great challenge and was traditionally managed by placement of a thoracic epidural catheter. However, recently the ESP block has gained ‘popularity’, even to abdominal analgesia. With this case, the authors showed that a lower continuous ESP block provides effective post-operative analgesia for sub-costal incision and can be a valid option to integrate multimodal analgesia schemes.
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