Background and Aims A shoulder surgical approach for total scapulectomy involves extensive anterior and posterior incisions, which affects C5-T5 dermatomes. An analgesic approach to the brachial plexus is insufficient, paravertebral or thoracic epidural blocks are more invasive and pectoral and serratus blocks cover only the anterolateral chest wall. The erector spinae plane block (ESPB) allows analgesia of the anterior, lateral and posterior chest wall and also lower cervical roots, when performed at a high thoracic level (1,2,3).
Methods We present the case of a 64 years old male with a sarcoma of the left shoulder with scapular invasion, proposed for scapulectomy. After the surgery, under general anesthesia, the ESPB was performed at T3 level with 20 mL of 0.25% levobupivacaine followed by catheter placement. No pain ou complicantions were in the immediate postoperative period as well as in the next days, reciving 20 ml mandatory bolus of 0.2% ropivacaine every 4h and 1g of acetaminophen every 8h.
Results Considering our literature review, this is the first case described with the application of ESPB for post-scapulectomy pain control. We choose the T3 level in an attempt to achieve a C5-T5 craniocaudal dispersion. Given the possibility that the uppermost dermatomes were not reached, the infiltration of the brachial plexus exposed by the surgical incision and superficial cervical block were also performed. With this tecnhique, a pain and complication free postoperative period was achived.
Conclusions Being an anatomically easy and safe block to perform with ultrasound support, we consider that it could become the first option in regional analgesia for scapulectomy.
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