USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: A report of two cases

Abstract

The postoperative pain management in open thoracotomy is very crucial as the effective analgesia can prevent respiratory and thrombotic complications and lead to early mobilization and discharge. The thoracic epidural analgesia is the gold standard in such surgeries; however, there are few adverse effects such as hypotension, dural puncture, and contralateral block that always warrants safer alternative. Recently, with the advent of ultrasound, the regional anesthetic techniques are getting more popular to avoid such complications. Erector spinae plane (ESP) block is one of the novel techniques that has been described as a safe thoracic paravertebral block. We are reporting here the continuous ESP block as a primary mode of postoperative analgesia which was continued for 48 h. The intraoperative opioid requirement was very less, and the maximum NRS score in postoperative period was 4 at 12 h, which was well managed with multimodal analgesic regimen along with rescue doses of opioid.

Keywords: Continuous; erector spinae block; thoracotomy.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1

Longitudinal scan at T4–5 transverse process level with arrow mark showing 20 g catheter exiting from Tuohy needle tip. RM: Rhomboid major muscle; ESM: Erector spinae muscle

Figure 2

(a) Low-frequency probe (2–5 Hz) placed over T3–4 transverse process level with a patient in the right lateral decubitus position. (b) Tuohy needle introduced craniocaudally with tip just below the erector spinae muscle. (c) Catheter secured with Tegaderm