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Abstract
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Background and Aims Thoracic trauma, often resulting from falls, poses significant challenges in pain management. We present a case of a 61-year-old male patient with thoracic trauma following a 2-meter fall. The patient presented with tachypnea and left hemithorax pain. Initial imaging revealed a pneumothorax, along with fractures of the 5th to the 9th left ribs. Due to severe pain and to prevent mechanical ventilation, the anesthesia team was consulted for pain management intervention.
Methods The patient consented to erector spinae plane catheter placement for pain control. Under ultrasound guidance, single-shot injections of ropivacaine 0.2% were administered at the erector plane at the level of the transverse process of T7. Additionally, two catheters were placed, one with cephalic orientation and the other caudally. A drug infusion balloon was connected to both catheters, delivering ropivacaine 0.2% at 5 ml/hour.
Results Following the intervention, the patient‘s pain score decreased from 10 on the Visual Analog Scale (VAS) to 5 after the single-shot injection. Continuous infusion via the bilateral catheters maintained the VAS score at 4 for up to 48 hours post-procedure, with no reported side effects.
Conclusions This case highlights the efficacy and safety of double catheter on the erector spinae plane for optimizing the pain management in thoracic trauma patients, offering prolonged relief, and potentially reducing the need for systemic opioids and mechanical ventilation.
- Ultrasound image of the approach to erector spinae plane block (ESPB), with caudal and cephalic catheters crossed at T7 level. Ca – caudal cateter; Ce – cephalic catheter; ES – erector spinae; TP – transverse process
– External view of the caudal and cephalic catheters placement
– Caudal and cephalic catheters connected to a 48-hour Drug Infusion Balloon (DIB)