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Background and Aims Erector spinae plane block (ESPB) has been used successfully in chronic shoulder pain management, however ESPB has not been widelly used as a postoperative analgesia in shoulder surgeries. The aim of this case presentation was to describe the use of bilateral high thoracic erector spinae plane block for provision of analgesia for bilateral single staged shoulder arthroplasty.

Methods 66 years old patient, ASA score II, underwent bilateral single staged shoulder arthroplasty due to sustained trauma. Bilateral ESPB at T2-T3 level was performed with 20ml of 0,375% levobupivacaine before standard general anesthesia induction for postoperative analgesia. Informed consent was obtained for reporting this case report. Sheduled postoperative patient analgesia was paracetamol 1g every 8h and ketorolac 30mg every 8h. Postoperative pain scores were recorded with numerical rating scale (NRS) on the 1st, 2nd, 4th, 8th, 16th, 24th and 48th hour after the procedure. Opiod consumption and adverse effects ( nausea, vomiting, respiratory failure, hematoma ) were also recorded.

Results The postoperative NRS scores: for the 1,2,4th hour were 0-2, for the 8th hour 8 and as a rescue analgesia for the breakthrough pain tramadol 100mg was administred, for the 16th 3, 24 and 48th hour were 0-1. Total 48 hours tramadol consumption was 100mg and no aditional opiod. No side effects or complications related to the block were noticed.

Conclusions Ultrasound guided high thoracic erector spinae plane block can provide effective analgesia in shoulder surgery. As a phrenic nerve sparing block it can be alternative to routinely used interscalene block.