Background and Aims A 16 year old male suffered a stab wound to right posterior lower thorax. CT showed a right hydrohaemopneumothorax & right renal laceration and chest drain was inserted. The patient became unstable during opertation requiring a clam shell thoracotomy. The patient’s haemodynamics improved with multiple blood product transfusions and repeat CT showed an enlarging right peri-nephric haematoma, and shattered right kidney. He was admitted to ICU for Respiratory weaning but adequate analgesia was challenging, coagulopathy and rising inflammatory markers ruled out epidural. Bilateral erector spinae plane infusions were sited to optimise analgesia.
Methods ESP catheters were inserted at T5 bilaterally. Nerve catheters were placed under ultrasound guidance and 60 ml of 0.25% Levobupivacaine (adrenaline 1:400 000) loading dose administered. A continuous infusion of levobupivacaine at 15 ml/hr was commenced and bolus doses prescribed.
Results ESP catheter infusion continued at 10–15 ml/hr for 10 days with 40 ml of 0.125% levobupivacaine bolus top-ups. The patient was extubated D10 ESP infusion and the infusion was weaned – patient reported 0/10 pain. He was transitioned to regular analgesics with regular pregabalin and PRN oxycodone & discharged to the ward.
Conclusions ESP can be considered as a part of analgesia regime in appropriately selected patient groups. Multiple contra-indications exist in trauma settings. This patient’s coagulopathy contraindicated epidural insertion. However, an ESP could be safely inserted, achieving a good level of analgesia.
Overall, the ESP played a pivotal role in this patient’s ITU care and the overall recovery from his polytrauma.
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