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Abstract
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Background and Aims We present the case of an eight-year-old male, ASA III, with bilateral hip dislocation scheduled for bilateral hip reconstructive surgery (Klisic Procedure) planned for two different surgical times. His medical history included spastic quadriparesis secondary to traumatic brain injury at ten months, hydrocephalus managed with a ventriculoperitoneal shunt, epilepsy, and a severe platelet storage pool disorder
Methods Surgery was performed under general anesthesia with non-invasive and invasive monitoring (arterial line and central venous catheter), coagulation status monitoring with TEG, and avoidance of neuraxial techniques. The patient received a tranexamic acid infusion during both surgical interventions. For his left hip surgery, we provided analgesia with intraoperative fentanyl and lidocaine infusions, acetaminophen, a single-shot femoral nerve block, and rescue hydromorphone. One week after the first surgery, the patient underwent right hip surgery. This time he received an intraoperative ketamine infusion, acetaminophen and we placed an ultrasound guided erector spinae plane catheter at L4 level with a 0.125% bupivacaine infusion (0,3 mg/kg/h)
Results After the first surgery, the patient experienced severe postoperative pain after the resolution of a single-shot block, requiring high-dose opioids and management by the pain service. Following the second surgical stage and ESP block, hydromorphone rescue doses were not required and adequate postoperative pain management was achieved.. The patient was discharged six days after the second surgery.
Conclusions In the presented case, the ESP block was a safe and effective option for postoperative pain management in patients with multiple comorbidities undergoing Klisic surgery
Ultrasound of the ESP catheter