Background and Aims VATS has become the first treatment for patients undergoing lobectomy. Recent reports showed that ESPB improved postoperative analgesia after VATS.
ESPB is a technique introduced by Forero et al. Local anesthetic is injected between the erector spinae muscle and transverse process. Recent studies regarding the use of boluses for an ESPB catheter suggested that some patients do better with mandatory boluses than continuous infusions.
We report the use of the ESPB in intermittent boluses in a 69yrs man, with important comorbidities that underwent upper right pulmonary VATS lobectomy.
Methods After induction of general anesthesia, the patient was placed in lateral position and a linear-array transducer was placed in longitudinal orientation. After local anesthesia, an ESPB at T5 level is performed using an 18G Thuoy needle. After a bolus of 20 ml of ropivacaine 0.5%, a perineural catheter was placed, 6 cm beyond the needle tip (figure 1). After the surgery, a bolus of ropivacaine 0,2% (10 ml) was administered and subsequently boluses of 20 ml of ropivacaine 0,2% were administered every 8 hours up to 48 hours after surgery.
Results NRS pain score decreased immediately after every bolus. The patient performed successful respiratory rehabilitation. The length of hospital stay was reduced, and the patient reported comfort and satisfaction.
Conclusions The ESPB in intermittent boluses had no side effects and allowed a reduction in the consumption of opioids and therefore of post-operative nausea and vomiting. It could be an alternative to epidural anesthesia or Serratus Anterior Plane Block.
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