Erector spinae block for postoperative analgesia following axillary hidradenitis suppurativa resection: a case report

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions. Lesions can be severely painful on their own or following surgical resection. Patients may require opioid therapy due to pain from the lesions themselves or following painful surgical resection. Erector spinae block (ESB) is a recently developed plane block used for the management of pain located in the chest wall or the abdominal wall. Ultrasound guidance is used to guide placement of the needle tip between the transverse process at the desired dermatomal level and the erector spinae muscle group. Traditional descriptions of the ESB have been at the level of the fifth transverse process to treat chest wall pain; in this case report, we describe a novel use of ESB at the level of the second transverse process to treat axillary pain after surgical debridement of axillary HS.

Keywords: axillary analgesia; axillary pain; erector spinae block; hidradenitis suppurativa; peripheral nerve block; thoracic analgesia; thoracic wall block; truncal blocks; ultrasound-guided blocks.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1

Ultrasound image of the three muscle layers. Notes: TM, RMM, and ESM overlying the T2 TP. LA spread is seen in between the ESM and T2 TP. Abbreviations: ESM, erector spinae muscle; LA, local anesthetic; RMM, rhomboid major muscle; TM, trapezius muscle; TP, transverse process.

Figure 2

Extent of diminished sensation to pin prick on postoperative day 1; right shoulder and right scapula.

Figure 3

Extent of diminished sensation to pinprick on postoperative day 1; right axilla and right anterolateral chest wall.