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B231 Prolonged erector spine plane block as an effective method of reducing chronic pain after spine surgery
  1. M Barsa1,2
  1. 1Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
  2. 2Public Heals Care Institution “Yuriy Semenyuk Rivne Regional Clinical Hospital” supervised by Rivne re-gional council, Rivne, Ukraine


Background and Aims Osteochondrosis is one of the most common causes of back pain. Methods of its treatment range from conservative to complex transpedicular fixations of spine with decompression. In the most difficult cases, despite adequate surgery, pain might return with no less intensity. Aim: reduce the intensity of chronic postoperative pain by prolonged ESP-block.

Methods Patient after posterior metal-autospondylodesis Th11-L4 was admitted with muscular-tonic syndrome of musculus iliopsoas, plexopathy of the right lumbar plexus with severe pain. Under X-ray control, a Tuohy 18G needle was inserted toward the L2 transverse process, then 20G catheter was passed through the needle under the erector spine muscle at a distance of 2 cm from the tip of the needle. To verify the location of the catheter tip and the spread of the anaesthetic, 10 ml of yogexol was injected through the catheter and an X-ray was taken.

7-day patient-controlled infusion of 0.25% bupivacaine followed. Outcomes: visual analogue scale scores at rest (VASr) and movement (VASm), mechanical pain thresholds before ESP-block (MPTb) and 7 days after catheter removal (MPTa).

Results VASr and VASm before catheterisation - 6 and 8 respectively, duaring infusion - 2 and 3, 7 days after catheter removal - 3 and 4. MPTb - 61,7 gr/mm2, MPTa - 52,6 gr/mm2.

Conclusions Erector spine plane block can be used to treat severe pain despite its etiology. The use of X-rays to perform blockade can be an alternative technique during this procedure for patients in case ultrasound imaging is technically difficult or impossible due to different reasons.

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