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Abstract
Background and Aims Open nephrectomy is associated with moderate to severe postoperative pain.1 Erector spinae plane block (ESPB) provides effective analgesia for various surgical procedure but only a few reports on ESPB used for pain control in open nephrectomy.2 We reported two cases of continuous ESPB as multimodal analgesia and intraoperative hemodynamic stability in open nephrectomy for living donor kidney transplant.
Methods Two adult patients underwent open nephrectomy for living donor renal transplant. ESPB was performed before general anesthesia with ultrasound guided using high frequency linear probe at level of T8-T9. After transversus process and erector spinae muscle were identified, hydro dissection with 2 ml of normal saline was used to confirm the correct needle tip position. 18-gauge epidural catheter then inserted into the plane between erector spinae and transverse process. 20 ml local anesthetic 0,25% levobupivacaine was injected and spread of local anesthetic under erector spinae muscle was seen by ultrasound. For postoperative pain control, patients were administered 10 ml levobupivacaine 0,125% via catheter at the end of surgery, continuous levobupivacaine 0,125% 6 ml/hour and paracetamol 1 gr/8 hours. Vital sign was recorded intraoperatively. NRS was measured at recovery room, 6, 12, 24 hours postoperatively.
Results Hemodynamic instability was not observed during incision and intraoperatively. NRS was 2 in recovery room and ward. No additional opioid used intraoperatively.
Conclusions Continuous ESPB is effective to reduce pain, total opioid consumption and can be used as alternative for epidural analgesia. Prospective trials are needed to evaluate the efficacy of continuous ESPB for open nephrectomy.