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B98 Erector spinae plane block as part of a multimodal analgesic scheme in reconstructive breast surgery with transverse rectus abdominus muscle flap: a case report
  1. A Marques,
  2. R De Oliveira,
  3. L Coimbra and
  4. F Rodrigues
  1. Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal


Background and Aims The erector spinae plane (ESP) block is a recent regional anaesthetic technique that can be used to provide analgesia for a variety of surgical procedures.It consists in placement of local anaesthetic between the erector spinae muscle (ESM) and the thoracic transverse processes, blocking the dorsal and ventral rami of the thoracic and abdominal spinal nerves. It has been previously used for reconstructive breast surgery, however, to our knowledge,this is the first case in which it has been used as part of a multimodal analgesic scheme.

Methods We describe a 50-year-old female, ASA II,undergoing reconstructive breast surgery with transverse rectus abdominus muscle flap under combined anaesthesia. A bilateral ESP block was performed under ultrasound guidance at the T4-T6 level in the lateral position. After visualization of the ESM and the transverse process, 20 mL of 0.5%ropivacaine were administered bilaterally, followed by induction of general anaesthesia. Surgery was completed in 4 hours and opioides were not required. Analgesia was supplemented with intravenous acetaminophen (1 g) and ceterolac (30mg).

Results Postoperative pain relief was achieved with acetaminophen every eight hours. Pain levels varied between 0 and 3 in the Numeric Rating Scale. Complications were not reported.

Conclusions The over all result was increased satisfaction of the patient and avoidance of opioids. Other studies are necessary to evaluate the ESP block as a valid alternative in breast surgery.

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