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Background and Aims Managing postoperative pain after an open hepatobiliary surgery often presents a challenge. Use of regional anesthetic techniques is common to reduce opioid consumption and its associated side effects. Thoracic epidural analgesia is considered to be the gold standard for this type of surgery, however, it might be contraindicated due to abnormal coagulation, patient refusal, etc. In this study we evaluated the efficacy of continuous bilateral erector spinae block (ESPB) in this setting.
Methods ESPB was performed in 10 adult patients scheduled for open hepatobiliary surgery in whom thoracic epidural was contraindicated due to abnormal coagulation profile or patient refusal. Procedures included Liver-Lobectomy, Hepato-pancreato-biliary, Whipple and exploratory laparotomy. ESP catheters were inserted under US guidance at the level of T5-T6. At the conclusion of surgery, patients received a bolus of 10ml of 0.25% bupivacaine into each ESP catheter followed by a continuous infusion of 0.1% bupivacaine at 12-16mL/h into both catheters. Patients also received non-opioids around the clock for multimodal pain control. We used the maximal VAS score in every 8 hours for the whole duration of infusion which varied and opioid consumption was monitored.
Results Patient demographics, type of surgery, contraindication for thoracic epidural, VAS pain scores taken, 48 postoperative hour opioid consumption as well as duration of ESP are shown in table 1. All patients had successful placement of ESP catheters, no complications were noted. Pain scores were markedly low as well as opioid requirement.
Conclusions Continuous ESPB is a feasible and effective technique for providing analgesia following major open abdominal surgery.
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