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Abstract
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Background and Aims Erector Spinae Plane Block (ESPB) is a safe and effective analgesic alternative to epidural in patients with coagulation disorders. It was first applied in the paediatric population for postoperative pain management in 2017. It is particularly beneficial in the context of enhanced recovery following surgery protocols and multimodal analgesia. Single-shot or continuous infusion techniques have been previously described, and non-inferiority has been observed when compared with other locoregional techniques.
Methods A 10-year-old boy, weighing 38kg, ASA III, with chemotherapy induced pancytopenia, was scheduled for elective excision of Ewing’s sarcoma of the 7th, 8th and 9th ribs. Following parental consent, general anaesthesia was combined with a continuous ipsilateral ESPB, performed under ultrasound guidance at T7 level. A bolus of 19mL 0.2% ropivacaine was administered. Perioperative analgesia was completed with lidocaine (1mg/Kg), ketamine (0.3mg/kg). At the end of surgery, acetaminophen (15mg/Kg) and morphine(0.1mg/Kg) were administered. Postoperative infusion with 0.2% ropivacaine (7ml/h) was combined with 3ml boluses 3 times a day, fix acetaminophen/tramadol and ketorolac SOS.
Results During surgery the patient remained hemodynamically stable. Postoperative pain VAS remained low (0-1), and no rescue analgesia was needed. The catheter was removed on day 7 with extreme patient satisfaction.
Ewing Sarcoma Surgical Resection
Continuous ESP Block at T7
Conclusions In this case report we demonstrate that continuous ESPB provides safe and effective pain management, as part of multimodal analgesia for thoracic open surgery in a paediatric patient with pancytopenia. Therefore, ESPB may be considered to be an effective alternative to epidural block in children, even more so in cases of contraindication to the neuraxial approach.