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Background and Aims The Erector Spinae Plane (ESP) block is a good perioperative analgesia for thoracic, chest wall, abdominal, spinal and hip surgeries. A recent case report had demonstrated its efficacy in post-operative analgesia for an above-knee amputation, but no reports have been published on ESP for surgeries below the level of the knee. The authors would like to publish the first case report of effective use of lumbar ESP block with catheter for intra and post-operative analgesia for an extensive tibia endoprosthesis surgery.
Methods We report a 12-year-old male with non-metastatic osteosarcoma of the right proximal tibia undergoing tibia endoprosthetic surgery. ESV and his mother were keen for a block for supplemental analgesia but not involving the central neuraxial axis, so a lumbar ESP at L3 level was proposed. ESV was given a general anaesthetic and an ESP with catheter was sited at the level of the right L3 transverse process.
Results The patient underwent a 7-hour long resection of tumour and insertion of tibia endoprosthesis for which the ESP initial bolus was effective in achieving good intraoperative analgesia. Post-operatively, the ESP catheter was used to deliver programmed intermittent boluses (PIB) of local anaesthetic for analgesia in the first 3 post-operative days, while facilitating ambulatory physiotherapy.
Conclusions Our patient had demonstrated the efficacy of a lumbar ESP block in delivering good intraoperative analgesia for lower limb surgery. It also demonstrates that the continued use of a lumbar ESP catheter for PIB local anaesthetic boluses affords adequate analgesia without significant motor block and impediment to physiotherapy.
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