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• W2899237843 abstract "Thoracotomy is a procedure that causes severe pain as a result of muscle incision, retraction of the ribs, and damage to the intercostal nerves. Postoperative analgesia management is very important for respiratory functions, and successful pain management reduces postoperative complications and length of hospital stay.1Ballantyne J.C. Carr D.B. deFerranti S. et al.The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials.Anesth Analg. 1998; 86: 598-612Crossref PubMed Google Scholar A variety of procedures have been described for the first-step treatment of thoracic analgesia, including intercostal nerve blocks, thoracic epidural analgesia (TEA), and thoracic paravertebral blocks.2Gottschalk A. Cohen S.P. Yang S. Ochroch E.A. Preventing and treating pain afterthoracic surgery.Anesthesiology. 2006; 104: 594-600Crossref PubMed Scopus (236) Google Scholar However, their usage is limited because of complications and failure rates (up to 15% in TEA).3Romero A. Garcia J.E.L. Joshi G.P. The state of the art in preventing postthoracotomy pain.Semin Thoracic Cardiovasc Surg. 2013; 25: 116-124Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar The other option for analgesia is intravenous opioid medications that can be used in combination with nonsterioidal anti-inflammatory drugs.4Joshi G.P. Bonnet F. Shah R. et al.A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia.Anesth Analg. 2008; 107: 1026-1040Crossref PubMed Scopus (457) Google Scholar Adverse effects such as sedation, hypoventilation, nausea, and vomiting can occur, especially in systemic high opioid doses used for severe pain such as after thoracotomy. The ultrasound-guided erector spinae plane (ESP) block is one of the newly described interfascial plane blocks that provide thoracic analgesia at the T5 level5Forero M. Rajarathinam M. Adhikary S. Chin K.J. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: A case report.A Case Rep. 2017; 8: 254-256Crossref PubMed Scopus (113) Google Scholar and abdominal analgesia at the T7 to T9 level.6Chin K.J. Malhas L. Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: A report of 3 cases.Reg Anesth Pain Med. 2017; 42: 372-376Crossref PubMed Scopus (235) Google Scholar We were interested in ESP block because it is easily performed and safe under ultrasound guidance (USG).5Forero M. Rajarathinam M. Adhikary S. Chin K.J. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: A case report.A Case Rep. 2017; 8: 254-256Crossref PubMed Scopus (113) Google Scholar Therefore, we think that ESP block could be a good alternative to other techniques in postoperative analgesia management after thoracal surgery. In this report, we aimed to present our successful ESP block experience for a patient who underwent right lobectomy because of lung metastasis of colon cancer. Written informed consent was obtained from the patient for this report. We succesfully performed single-shot pre-emptive ESP block in a 57-year-old woman. After induction of anesthesia, the patient was placed in the left lateral decubitis position, and a unilateral ultrasound-guided ESP block was performed at the level of the T5 transverse process with the GE Vivid Q USG device. A high-frequency 12-MHz linear ultrasound probe was placed in a longitudinal orientation 3 cm from the midline (Fig 1A). The trapezius, rhomboid major, and erector spinae muscles were identified superficial to the hyperechoic transverse process shadow (Fig 1B). A 22-gauge, 80-mm block needle (SonoTap; Stimuplex Ultra, B. Braun Medical, Germany) was inserted in a cephalad-to-caudad direction in the interfascial plane deep to the erector spinae muscle. After aspiration there was no blood or air; the erector spinae plane was hydrolocated with 2 mL of normal saline. A total of 20 mL of 0.25% bupivacaine was injected (Fig 1C). Single shot block was performed; we did not use a catheter. A total of 250 μg of fentanyl and 1 g of paracetamol were administered perioperatively. The patient was extubated successfully at the end of surgery and transferred to the postanesthesia care unit (PACU). The patient was awake and comfortable in the PACU. The visual analog scale score was 2 at the PACU; additional analgesic was not given to her. Scheduled postoperative analgesia was 1 g of paracetamol every 8 hours, with a rescue dose of 50 mg of tramodol. At the 10th and 32nd hours, the visual analog scale score was 6 and 100 mg total of tramadol was added. In the postoperative period, the patient reported a sensory block at T2 to T10 dermatomes (evaluated with cold test). She received a total of only 100 mg of tramodol, without any other opioids required during 48 hours after surgery. After a 48-hour period, 1 g of oral paracetamol was ordered for every 8 hours. The ESP block contains a local anesthetic injection into the paraspinal tissues that is away from the pleural and neurologic structures and thus minimizes the risk of complications owing to injury.5Forero M. Rajarathinam M. Adhikary S. Chin K.J. Continuous erector spinae plane block for rescue analgesia in thoracotomy after epidural failure: A case report.A Case Rep. 2017; 8: 254-256Crossref PubMed Scopus (113) Google Scholar, 7Forero M. Adhikary S.D. Lopez H. Tsui C. Chin K.J. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain.Reg Anesth Pain Med. 2016; 41: 621-627Crossref PubMed Scopus (915) Google Scholar Visualization of anatomical guide points with USG is easy, and local anesthesic agents can be seen under the erector spinae muscle. The local anesthetics spread here, and analgesia occurs in several dermatomes in a cephalad-caudad way. Cadaveric studies have shown that the injection spreads to both the ventral and dorsal roots of the spinal nerves and creates sensory blockade in the posterior as well as the anterolateral thorax.7Forero M. Adhikary S.D. Lopez H. Tsui C. Chin K.J. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain.Reg Anesth Pain Med. 2016; 41: 621-627Crossref PubMed Scopus (915) Google Scholar The risk of pleural puncture is lowest compared to TEA and thoracic paravertebral blocks. Furthermore, because there are no large vascular structures around it, the risk of a clinically significant hematoma is low. We did not use a catheter for our case because our aim was to see the effectiveness of the single-dose pre-emptive ESP block for thoracic surgery. Our patient was comfortable in the postoperative period and did not need any more opioid. In summary, preemptive single-shot ESP block can be performed as an alternative in postoperative pain management because it is easy to use, a central block-like analgesia can be obtained with it, and it has no risk of serious complications such as pneumothorax." @default.
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• W2899237843 date "2019-04-01" @default.
• W2899237843 modified "2023-10-04" @default.
• W2899237843 title "Ultrasound-Guided Single-Shot Preemptive Erector Spinae Plane Block for Postoperative Pain Management" @default.
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