Background and aims The erector spinae plane (ESP) block is a novel technique in which local anesthetic (LA) is deposited in the fascial plane deep to the erector spinae muscle and superficial to the tip of the transverse process. Prospective study was undertaken to evaluate the efficacy of erector spinae block (ESPB) for thoracic surgery for children below age of five. Single shot ESPB, continuous or repeated via catheter was performed for thoracic surgery and evaluating its effects on intraoperative anaesthetic requirement, postoperative analgesia.

Methods Thirty-five paediatric patients aged below 5 years (1 day-5 years, 2,8 kg-18 kg) undergoing thoracoscopic or thoracotomy procedure mostly for thoracic empyema or oesophageal atresia. After tracheal intubation received/was inserted single shot or catheter under ultrasound guidance. Inicially all patients received 0,5 ml/kg of 0,25% levobupivacain and catheter group continued as infusion of 0,2 ml/kg/h 0,125% or repeated boluses 0,25% levobupivacain 6 hourly for 72 hours. Perioperative opioid consumption, postoperative pain score, the time to first demand of analgesia and number of rescue analgesic demands were noted and compared to historical cohort. Seven patients were tested for blood level of local anaesthetics on the second and third postoperative day.

Results Erector spinae plane block is technically simple, safe and effectively provides perioperative analgesia with significant reduction of opioids to nearly opioid free anaesthesia level.

Conclusions To prolong analgesic effect to postoperative period if more efficient repeated boluses regime than continuous infusion regime. Blood levels of local anaesthetics are higher after boluses but still below toxic level in each age groups.