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180 Erector spinae plane block for tram – on the way to eras?
  1. LA Montenegro Ledo1,
  2. AR Santos Almeida Silva1,
  3. TR Alves Martins1,
  4. I Rodrigues2,
  5. HM Cunha Gomes Santos3 and
  6. EC Pereira1
  1. 1Hospital Garcia de Orta, Almada, Portugal
  2. 2Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
  3. 3Hospital CUF Tejo, Lisboa, Portugal


Background and Aims Erector spinae plane block (ESPB) is a newly described interfascial block, consisting in injection of local anesthetic in plane between transverse process and erector spinae muscles. It has emerged as a good alternative for analgesia of entire hemithorax.

TRAM flap reconstruction is traditionally associated of severe pain, requiring opioid analgesia, with all known side effects.

This case reports an opioid-free anesthesia for TRAM flap reconstruction, using ESPB.

Methods Female, 53-years, ASA III, with hypertension, obesity and SAOS, admitted for TRAM flap reconstruction.

Bilateral ESPB was performed, under ultrasound guidance. It was injected 25 ml of ropivacaine 0,375% (2.6 mg/kg) and dexamethasone 4 mg on each side, at T4 level.

Under ASA standard and invasive blood pressure monitoring, a totally intravenous general anesthesia was maintained with propofol and ketamine.

Acetaminophen and ketorolac were administered 30 minutes before end of surgery. No complications recorded during intra-operative period and patient emerged comfortable from anesthesia.

Results On PACU, patient remained comfortable with maximum pain of 1/10 on NRS, without need of additional analgesics.

Postoperative analgesia consisted of acetaminophen and ketorolac every 8 hours and, during first 2 days, the worst pain recorded was 3/10, without need of opioid analgesia.

No complications of the ESPB was recorded and patient was discharge home after 4 days.

Conclusions ESPB is useful, easy and fast strategy that may be used as a valuable adjunct for postoperative analgesia in TRAM flap reconstruction, which pose a challenge in pain control.

Moreover, it offers an advantage in terms of reducing opioid requirements contributing for enhanced recovery.

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