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Background and Aims Erector spinae plane (ESP) block is an interfascial plane block. There are reports in patients undergoing spinal, breast, thoracic and abdominal surgeries with some conflicting results.
Results A 22 year old healthy woman suffered a penetrating trauma between the chest and armpit with a wooden stick. An uneventfully general anaesthesia was performed to remove it and she went to the ward with continuous intravenous analgesia with drug infusion balloon (DIB). After surgery patient was conscious reporting severe pain and paresthesia in the median nerve territory despite multimodal analgesia. On the second postoperative day the intravenous infusion was stopped because nausea and vomiting. The pain, located mainly in the axilla, was controlled at rest but severe when moving, preventing rehabilitation therapy. It was performed an ultrasound-guided continuous ESP block at T4 level and 20 mL 0.2% Ropivacaine was injected. 8 mg intravenous dexamethasone was administered. There were no intercurrences and the patient reported great relief of pain. A perineural infusion of 5 mL/h 0.2% Ropivacaine was started. On the next days it was possible to do rehabilitation therapy and pain on mobilization progressively improved. On the seventh postoperative day the infusion was stopped because pain control was found at rest and in movement, without rescue analgesia.
Conclusions The mechanism of action of the ESP block is a matter of debate. It was evident that the bolus contributed significantly to pain control when it was administered and the continuous block facilitated the rehabilitation therapy.
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