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Erector Spinae Plane Block As Regional Anesthesia Technique For Non Intubated Video Assisted Thoracic Surgery A Case Series
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Book Synopsis ERECTOR SPINAE PLANE BLOCK AS REGIONAL ANESTHESIA TECHNIQUE FOR NON-INTUBATED VIDEO ASSISTED THORACIC SURGERY, A CASE SERIES by : Muhammad Aulia Arifahmi
Download or read book ERECTOR SPINAE PLANE BLOCK AS REGIONAL ANESTHESIA TECHNIQUE FOR NON-INTUBATED VIDEO ASSISTED THORACIC SURGERY, A CASE SERIES written by Muhammad Aulia Arifahmi and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and AimsThe Erector spinae plane (ESP) block is a relatively new technique for variety of applications, from control of acute postoperative pain to chronic pain. It is an inter-fascial plane block where high volume local anesthetic is injected in a plane preferably below the erector spinae muscle. Its site of action is likely at the dorsal and ventral rami of the thoracic spinal nerves. This technique produced an extensive multi-dermatomal sensory and visceral block; however there is still limited evidence of its use for sole regional anesthesia. In this study, we report 5 cases of the ultrasound guided ESP block as regional anesthesia technique for non-intubated video assisted thoracic surgery (VATS).MethodsFive patients (aged 54 to 78 years old) diagnosed with unilateral massive pleural effusion, lung tumor, and moderate to severe restrictive COPD, underwent VATS procedure with regional anesthesia ESP block for diagnostic, pleural drainage, and lung tumor biopsy. Using ultrasound guided technique, we identified musculus erector spinae at 3cm lateral of vertebrae T5 level at seated position. Then local anesthetic 20cc of ropivacaine 0.375% were injected via needle at the plane below the musculus erector spinae, until its spread cranially to caudally could be visualized by ultrasound. We evaluate that complete block over T3 to T7 hemi-thorax is achieved within 30 minutes, and could facilitate the entire surgery. All VATS procedure in this case finished within 1 hour.ResultsWe were successfully administered regional anesthesia ESP block to four patients. They didn't require general anesthesia or additional analgesics during VATS procedure. Combined with NSAID and tramadol for 48 hours post-operative pain management, they had 0-2/10 pain numerical rating scale. However, we had to switch one patient to general anesthesia due to inadequate block result within 30 minutes evaluation.ConclusionESP block holds promise as a simple and safe alternative anesthesia technique for non-intubated VATS procedure, but it needs further research to proof its effectiveness and reliability.
Book Synopsis Erector Spinae Plane Block: a New Regional Analgesic Option for Thoracoscopy by : Lorena Gomez Diago
Download or read book Erector Spinae Plane Block: a New Regional Analgesic Option for Thoracoscopy written by Lorena Gomez Diago and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND:A novel interfascial block has been applied by Forero et al.'s in patients with severe thoracic neuropathic pain and acute postoperative pain after thoracoscopy (1). We read with interest the description of the erector spine plane (ESP) block and the anatomy revision made in this article.Therefore, we would like to describe a case were this new regional technique has been applied for a thoracoscopic procedure.This surgery requires general anaesthesia and one- lung ventilation. Analgesia involves fentanyl during surgery and non-steroidal anti-inflammatory drugs postoperatively. Regional analgesia techniques, as epidural or paravertebral blocks, are usually not performed and are not justified in this type of procedures. Although other regional blocks of the chest wall such as pectoral block and serratus block have recently been proposed, evidence indicates that they may not cover the surgical area.The ESP block seems to affect both dorsal and ventral rami of the thoracic spinal nerves and good quality of analgesia may be achieved with less potential complications. Cadaver investigations performed by these authors showed penetration of injectate anteriorly through the costotransverse foramen and into the vicinity of the origin of the dorsal and ventral rami when dye was injected into the interfascial plane posterior to the erector spinae muscle. This spread was not observed with injection superficial to erector spinae muscle.CASE REPORT:We performed this new regional technique in a patient who underwent thoracoscopic surgery for superior left lobe lung resection.Before the induction of anaesthesia the patient was positioned in right lateral decubitus with the upper limb along the body. We believe that this block can be easily performed in this position and more comfortabily for the patient.The ultrasound screen was positioned in front of the operator who stayed behind the patient for a better control of the probe. As for the paravertebral block, anatomic landmarks (shoulder blade and spinal levels) were marked to determine the level at which the ESP block should be performed. The linear ultrasound probe was positioned on the left side with longitudinal orientation 3cm lateral to the T5 spinous process. First, an horizontal scan of the area was performed and three muscles, superficial to the transverse process, were identified by this order: trapezius, rhomboid major and erector spinae. Second, a 100 mm block needle was inserted in plane with a caudal orientation until the posterior interfascial space of the erector spinae muscle. A total of 20 ml of levobupivacaine 0,25% was injected in this area with a single injection. After reading the Forero u0301s cadaveric study we choose to inject the local anesthetic in the deep interfascial space over the superficial. Afterwards the patient was submitted to a general anaesthesia which went uneventfully.In the postoperative care pain assessment the patient showed an EVA 0 in movement as resting, also maintaining thermoanalgesic sensibility. It was completely symmetric with contralateral side. Controls were made at 12, 24 and 48h. EVA 0 did not change in any control, being the coadyuvant analgesia minimally needed. Due to this optimus analgesic control the patient was able to breath deeply and make a very efficient breathing physiotherapy.The patient was discharged at 72h without reporting any complication neither needing rescue analgesia. He also had an adequate FRC.DISCUSSION:We think that this new regional block can be a paramount tool to control acute postsurgical pain after minimal invasive thoracic surgery. However, due to the lack of evidence of the ESP block in the acute pain setting, further studies should be performed to evaluate this technique.
Book Synopsis USE OF THE ULTRASOUND GUIDED ERECTOR SPINAE BLOCK AS AN ALTERNATIVE ANESTHESIA METHOD IN A SELECTED VIDEO ASSISTED THORACOSCOPY CASE by : Tulgar Serkan
Download or read book USE OF THE ULTRASOUND GUIDED ERECTOR SPINAE BLOCK AS AN ALTERNATIVE ANESTHESIA METHOD IN A SELECTED VIDEO ASSISTED THORACOSCOPY CASE written by Tulgar Serkan and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Video assisted thoracoscopy (VATS) is a frequently used method for both therapeutic and diagnostic purposes. VATS is usually performed under general anesthesia however, paravertebral block or other regional techniques could be used as an option in selected patients undergoing thoracoscopic diagnostic biopsy. In this case presentation, we present the application of ultrasound guided erector spinae block (ESPB) for the management of a VATS case as a main anesthesia method in a 58 years old male patient. ESPB at level of T5 was applied under sedoanalgesia anda mixture of local anesthetics was applied between transverse process and erector spinae muscle. The sensorial block between T2-T7 dermatomes was confirmed after 30 minutes following block application. Sampling of deep dermal and subcutaneous surgical tissue biopsies, dissection of lung parenchyma and thoracic wall were successfully completed . Total dose of 30 mg intravenous ketamine was appliedduring the surgery. ESPB may be used for anesthesia in suitable diagnostic VAS cases.
Book Synopsis BILATERAL ERECTOR SPINAE PLANE BLOCK FOR SURGERY ON THE POSTERIOR ASPECT OF THE NECK: A CASE REPORT by : Gavin Leslie
Download or read book BILATERAL ERECTOR SPINAE PLANE BLOCK FOR SURGERY ON THE POSTERIOR ASPECT OF THE NECK: A CASE REPORT written by Gavin Leslie and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUNDThe erector spinae plane (ESP) block is an interfascial plane block. Local anaesthetic is injected within the plane deep to the erector spinae muscle and superficial to the transverse process. It spreads craniocaudally leading to a multi-dermatomal sensory block. Its mechanism of action is still debated despite extensive cadaveric and radiological examination1, 2. To date, the ESP block has been used to provide analgesia in thoracic, abdominal and lumbar regions. It has even been used to provide complete surgical anaesthesia for mastectomy and axillary dissection3. We present the first case of the ESP block being used to provide complete surgical anaesthesia in the cervical region.HISTORY OF CASE REPORTA 50-year-old male with a large infected sebaceous cyst overlying the C2-4 spinous processes was admitted under the general surgeons. His numeric rating scale pain score was 7 at rest and 10 on movement despite paracetamol and oral morphine. Antibiotics yielded no improvement. The surgeon abandoned incision and drainage under local anaesthetic tissue infiltration because the patient could not tolerate it. He had multiple risk factors for a general anaesthetic including obstructive sleep apnoea, a BMI of 50 and a predicted difficult airway.CLINICAL PROCEDUREBilateral ultrasound-guided ESP blocks were performed at the level of the second thoracic vertebra with a curvilinear probe. 20mL of ropivacaine 0.375%, lignocaine 1% and adrenaline 1:400,000 was injected on each side.Testing after 15 minutes revealed loss of cold sensation over the C4 to T4 dermatomes. Midazolam 0.5mg and 20-30mg boluses of ketamine (totalling 120mg) given pre-emptively provided mild sedation. The patient remained in verbal communication and fully cooperative throughout. He tolerated the procedure well and he remained comfortable without further opiates until discharge.SUMMARYThe ESP block is an increasingly popular regional anaesthetic technique. It is easy, safe and quick to perform. This case contributes to the ever-expanding applications of this novel technique.
Book Synopsis 1 - COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK AND THORACIC PARAVERTEBRAL BLOCK FOR POSTOPERATIVE ANALGESIA AFTER VIDEO-ASSISTED THORACIC SURGERY: A PROSPECTIVE RANDOMIZED NON-INFERIORITY TRIAL by : Taro Fujitani
Download or read book 1 - COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK AND THORACIC PARAVERTEBRAL BLOCK FOR POSTOPERATIVE ANALGESIA AFTER VIDEO-ASSISTED THORACIC SURGERY: A PROSPECTIVE RANDOMIZED NON-INFERIORITY TRIAL written by Taro Fujitani and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and aims: The anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We conducted a study to clarify the analgesic efficacy of ESPB compared to that of thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracic surgery (VATS).Methods: This study was a prospective randomized non-inferiority trial approved by the Institutional Review Board of Ehime Prefectural Central Hospital (No. 29-84, 02/03/2018). Eighty-eight patients scheduled for VATS were randomly allocated to either an ESPB or a TPVB group. Patients in both groups received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after 20 mL of 0.2% levobupivacaine bolus injection. The primary outcome was postoperative numerical pain rating score (NRS) at rest 24 hours postoperatively, with a maximum acceptable difference (non-inferiority margin) between the groups as 1. We also evaluated NRS during movement, amount of rescue fentanyl used, and anesthetized dermatome number.Results: Eighty-one patients completed the study. NRS at rest was significantly lower in the TPVB group at 1, 2, and 24 hours postoperatively (respective p values = 0.018, 0.008, and 0.030). There were no significant differences in NRS during movement. The median difference in NRS at rest 24 hours postoperatively was over 1, which failed to demonstrate non-inferiority. The number of anesthetized dermatomes at parasternal regions was significantly greater in the TPVB group (p
Book Synopsis CONTINUOUS ERECTOR SPINAE PLANE BLOCK WITH EPIDURAL CATHETER FOR POSTu2011OPERATIVE ANALGESIA FOLLOWING THORACIC SURGERIES: A CASE SERIES by : ALI RAZA KHAN
Download or read book CONTINUOUS ERECTOR SPINAE PLANE BLOCK WITH EPIDURAL CATHETER FOR POSTu2011OPERATIVE ANALGESIA FOLLOWING THORACIC SURGERIES: A CASE SERIES written by ALI RAZA KHAN and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background & Aims:Erector spinae plane block (ESPB) is a novel regional analgesia technique for thoracic and abdominal surgeries. It can be employed for analgesia as an alternative to epidural block in patients presenting for thoracic surgeries. ESPB provides adequate analgesia, is technically easier to perform, and safer due to lower risk of serious complications as compared to epidural block. We have illustrated this by presenting a case series of thoracic surgeries in which an ESPB catheter was used for postoperative analgesia. We reviewed our SOP regarding use of continuous ESPB use for thoracic surgeries.Methods:35 patients (ASA-III/IV) who underwent thoracic surgery (VATS, thoracotomy) under GA were included. Ultrasound-guided, 16-G epidural catheter was inserted at T5 level cephalo-caudally. 30 mL of 0.25% bupivacaine in ESPB administered prior to incision supplemented with Tramadol (1 mg/kg IV). Postoperatively ESPB infusion was started at 10 mL/h of 0.1% bupivacaine. The dose and catheter management in rooms/ward was done by anesthesia technicians. The outcomes assessed were number of hours in PACU stay, VAS 2 hourly in PACU and then 8 hourly in rooms/ward), safety profile and number of days of catheter in situ. Rescue analgesia was Tramadol 0.75 mg/kg IV SOS, Ketorolac 0.5 mg/kg IV BD (if not contraindicated) and Paracetamol 1 g IV TDS. The authors certify that appropriate consent were obtained from the patients and their identity is not been disclosed.Continuous Erector Spinae Plane block with epidural catheter for post-operative analgesia following thoracic surgeries.A case seriesResults:Patient stay in PACU was for 8u00b14 hours. Mean VAS 2 hourly in PACU was 3u00b12 while mean VAS 8 hourly in room/ward was 1u00b11. None of the patients had hypotension necessitating vasopressor support, and the catheter remained in situ for 4u00b12 days. 34.2% (N=12) patients who experienced VAS 5, required supplemental analgesia.Discussion:TEA and PVB are mostly chosen as the first line regional analgesic techniques in thoracic surgeries for the pain management.[1, 2] When there is a contraindication or failure of these blocks, intercostal nerve block remained as an alternative but necessitating multiple injections. ESP block can serve as an alternative either as a single dose or as a continuous catheter based infusion for post-thoracotomy pain. Forero et al.[3] demonstrated ESPB as rescue analgesia in thoracotomy after a failed epidural. They revealed comparable pain score between TEA and ESP block until 12 h postextubation. The VAS scores remained to be persistently u22644 until 48 h in either of the group.Conclusions:Our case series reflects that ESPB provides adequate postoperative analgesia with no hemodynamic compromise in patients undergoing thoracic surgeriesReferences1 Romero A, Et. al. The state of the art in preventing postt-horacotomy pain. Semin Thorac Cardiovasc Surg. 2013;25:116u201324.2 Yeung JH, Et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;2:CD009121.3 Forero M, Et al. Continuous ESPB for rescue analgesia in thoracotomy after epidural failure. A Case Rep. 2017;8:254u20136.
Book Synopsis 6 - SENSORIAL ANALYSIS OF LOWER THORACIC ERECTOR SPINAE PLANE BLOCK; MISSING PIECE IN THE PUZZLE. by :
Download or read book 6 - SENSORIAL ANALYSIS OF LOWER THORACIC ERECTOR SPINAE PLANE BLOCK; MISSING PIECE IN THE PUZZLE. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Erector spinae plane block (ESPB), is a recent and popular block with a few reported complications. We report our clinical experience of ESPBu2019s in 308 patients, block related complications and unexpected events. The indication of block, application level of the block, details of local anesthetic drugs together with complications and unexpected events, such as artery puncture hematoma, infection, at the moment of block application and in following 24 hours were recorded in the forms. A total number of interventions were 479 and in only one patient experienced motor weakness. A total of 4 patients had suspicious minor neurological findings related to local anesthesia toxicity. No major neurologicalor minor / major cardiological findings were observed. Only a one bilateral sensory block case and a complete epidural block were the other unexpected events. Therefore, it can be proposed that ESPB is a regional anesthesia technique with a low complication rate.
Book Synopsis 5 - BILATERAL THORACIC CONTINOUS ERECTOR SPINAE BLOCK FOR PAIN RELIEF IN MULTIPLE BILATERAL RIB FRACTURES WITH FLAIL SEGMENT-A CASE REPORT by : Isaac Babu
Download or read book 5 - BILATERAL THORACIC CONTINOUS ERECTOR SPINAE BLOCK FOR PAIN RELIEF IN MULTIPLE BILATERAL RIB FRACTURES WITH FLAIL SEGMENT-A CASE REPORT written by Isaac Babu and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Rib fractures: relationship with pneumonia and mortality. Crit Care Med 2006; 34: 16422.Blanco R.The u2018pecsblocku2019: anovel techniquefor providing analgesia after breastsurgery.Anaesthesia2011;66:847u201383.Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block.Anaesthesia2013;68:1107u2013134.Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block. A novel analgesic technique in thoracic neuropathicpain.RegAnesthPainMed2016;41:621u201375. Ho AM, Karmakar MK, Critchley LA. Acute pain management of patients with multiple fractured ribs: a focus on regional techniques.CurrOpinCritCare2011;17:323u201376. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth 2017;118:474-5. 7. Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: A systematic review. Eur J Cardiothorac Surg 2014;45:959-66.8. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017;72:452-60. AuthorsJesto Kurian , Isaac BabuAddress for correspondenceDr Jesto KurianConsultant AnaesthesiologistDepartment of anesthesiology,Rajagiri Hospital,Aluva ,KochiEmail: [email protected].
Book Synopsis Continuous ERECTOR SPINAE PLANE BLOCK: First Choice in Perioperative Analgesia in Thoracotomy Surgery? by : Cristu00f3vu00e3o Tiago Pinto
Download or read book Continuous ERECTOR SPINAE PLANE BLOCK: First Choice in Perioperative Analgesia in Thoracotomy Surgery? written by Cristu00f3vu00e3o Tiago Pinto and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Backgroud and AimsThoracic epidural analgesia are currently the first line techniques for use in managing perioperative pain follow thoracotomy (1). Regional anesthetic techniques are strongly recommended primarily to reduce opioid use and the related adverse effects, including hypoventilation, sedation, nausea, and vomiting (2).In this way, continuous erector spinae plane (ESP) block is growing popularity because of its simplicity, safe and lesser side effects (1,2).We aim to present the result of the analgesic efficacy ofcontinuous ultrasound-guided ESP block in two cases of thoracotomy surgery.Case Report:65-year-old woman, presented for right inferior lobectomy (adenocarcinoma) and a 49-year-old woman, presented for left superior lobectomy (adenocarcinoma). Combined anesthesia (Balanced general anesthesia + continuous ESP) was performed. Before induction, the ultrasound-guided unilateral continuous ESP block was performed at the level of T5. 30 milliliters of ropivacaine 0,375% were administered.The multimodal approach for postoperative analgesia was: programmed intermittent mandatory boluses through the ESP catheter of ropivacaine 0,2% 8 ml/h + paracetamol 1g 8/8h + ketorolac 30mg 12/12h. Rescue analgesia with tramadol 100mg.The worst pain was 4 (numeric scale) 3 and 5 hours after surgery, respectively. At this time they both do tramadol 100mg. Beside this they donu00b4t need more rescue analgesia in the first 48 hours.ConclusionPain after thoracotomy can be difficult to control with a multimodal analgesia. Furthermor, thoracic epidural analgesia has potentially serious complications. Recently, ESP block has increased acceptance because it is a safe thoracic block with minor complications. With this two cases authors had shown that continuous ESP block provides effective post-operative analgesia follow thoracotomy with excellent pain control inside multimodal analgesic program with low opioids requirements.1- Forero M, Adhikary SD, Lopez H, et al. The Erector Spinae Plane Block: A novel analgesic technique in thoracic neuropatic pain. Regional Anesthesia and Pain Medicine. 2016 Sep u2013 Oct 41; 5: 621-27.2 - Forrero M, Rajarathinam M, Adhikary S, et Chin KJ. Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: ACase Report. . A & A Case Reports. MAY 15TH, 2017; 8(10):254u2013256.
Book Synopsis A Continuous Erector Spinae Plane Block In A Pediatric Patient by :
Download or read book A Continuous Erector Spinae Plane Block In A Pediatric Patient written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The guided ultrasound Erector Spinae Plane (ESP) block is a new, simple and safe technique of regional anesthesia, specially for the pediatric population 1.
Book Synopsis Cohen's Comprehensive Thoracic Anesthesia, E-Book by : Edmond Cohen
Download or read book Cohen's Comprehensive Thoracic Anesthesia, E-Book written by Edmond Cohen and published by Elsevier Health Sciences. This book was released on 2021-09-03 with total page 851 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ideal for clinicians at all levels of experience—from the resident to the subspecialist—Cohen's Comprehensive Thoracic Anesthesia compiles the many recent advances in thoracic anesthesiology into one convenient, easy-to-use reference. Concise, clinically focused chapters written by international authorities in the field cover all facets of anesthesia practice for thoracic procedures, logically organized by preoperative, intraoperative, and postoperative considerations. - Discusses new devices for lung isolation, new lung protection protocols, new information on post-operative complications, and new drugs for modulating pulmonary circulation. - Covers 20 key procedures including tracheal resection, esophagectomy, mediastinoscopy, mediastinal mass, SVC syndrome, and more. - Describes complex surgeries related to the lungs, pleura, diaphragm, and esophagus. - Provides case studies and clinical vignettes to illustrate and support case management decisions. - Offers highly practical guidance for quick reference from editor Dr. Edmond Cohen and a team of expert contributing authors from around the world. - Features extensive illustrations throughout, including clinical photos and drawings, radiographic images, device images, charts, and graphs.
Book Synopsis ERECTOR SPINAE PLANE BLOCK: WHEN PARAVERTEBRAL BLOCK IS NOT AN OPTION by : Daniel da Melo
Download or read book ERECTOR SPINAE PLANE BLOCK: WHEN PARAVERTEBRAL BLOCK IS NOT AN OPTION written by Daniel da Melo and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:The accomplishment of paravertebral block requires integrity of the parietal pleura and it should be avoided in cases of pleural empyema due to the risk of dissemination of the infection to the central nervous system.We present a case in which the erector spinae plane block (ESPB) was chosen as ananalgesic alternative to videothoracoscopic pulmonary decortication.Methods:75 years old, male, 64kg, hypertensive and smoker, with pleural empyema was scheduled to perform videothoracoscopic pulmonary decortication. Considering the contraindications to execute the paravertebral block, the anesthetic team decided to perform an ESPB for postoperative analgesia.At the end of the surgical procedure, with patient still in lateral decubitus, under general anesthesia, ultrasound guided ESPB was performed at T5 level with 20 mL of Ropivacaine 0.375% plus 50 mcg of Clonidine.ResultsAfter extubation, the patient awoke without complaints and was referred to intensive care unit (ICU). After 3 hours in ICU, the patient assigned grade 2 on numerical scale of pain intensity. The first request for complementary analgesia occurred after 5 hours in ICU.Conclusions:In patients with contraindication to paravertebral block due to parietal pleural damage or empyema, ESPB represents a regional anesthesia alternative in postoperative analgesia for thoracic surgeries.
Book Synopsis ERECTOR SPINAE PLANE BLOCK AS AN ALTERNATIVE TO EPIDURAL ANALGESIA IN KIDNEY SURGERY : A CASE REPORT. by :
Download or read book ERECTOR SPINAE PLANE BLOCK AS AN ALTERNATIVE TO EPIDURAL ANALGESIA IN KIDNEY SURGERY : A CASE REPORT. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ETIENNE A. 1, BOSMAN F. 1, JORION J-L. 2, VANDER ESSEN L. 1, SAMOURI G. 1 1.tAnesthesiology department2.tUrology surgery departmentThe erector spinae plane (ESP) block was first described in 2016 by Forero et al. (1). It involves the injection of local anesthetic into the interfascial plane, deep to erector spinae muscle (ESM), allowing the blockade of the dorsal and ventral rami of the thoracic spinal nerves. It was initially proposed for analgesia of costal fractures and pulmonary lobectomy (1).We report the case of a left nephrectomy, performed in a 61 years old man. The plan combined general anesthesia with an epidural catheter. After several unsuccessful attempts to place the epidural catheter, we performed a left ESP block. The needle was advanced in plane, and we injected 20 cc of a solution (Levobupivacau00efne 0.25% with epinephrine 1 / 200.000 and clonidine 75 microgram) deep to ESM at the level of T12.Postoperative analgesia included paracetamol, and PCA piritramide IV pump. Piritramide is an opioid commonly used in Belgium, with an analgesic ratio 0.7 versus morphine.No opioid consumption on recovery room, only 11 mg on day one, and 9 mg on the day two. The PCA was removed at the beginning of the second day and analgesia was performed only with paracetamol and tradonal.Altought epidural remains the first choice for lombotomy, this reported case shows the potential interest of an ESP block when an epidural is difficult or impossible. ESP block is easy to learn and safe. It would be interesting to think about the insertion of a catheter which could extend the duration of the analgesia.Bibliography1.tForero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41:621u20137.
Book Synopsis Ultrasound-guided Erector Spinae Plane (US- ESP) Block Associated to Dexmetomidine Cooperative Sedation for Anesthetic Management in Breast Cancer Surgery: a Case Report by : Giordano Carolina
Download or read book Ultrasound-guided Erector Spinae Plane (US- ESP) Block Associated to Dexmetomidine Cooperative Sedation for Anesthetic Management in Breast Cancer Surgery: a Case Report written by Giordano Carolina and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Ultrasound-guided Erector Spinae Plane Block (US-ESPB) is a recently described regional block technique for anesthesia and analgesia of the chest wall. Dexmetomidine (DEX) is an u03b1-2 agonist that can provide cooperative sedation during surgery. We reported a case of US-ESPB associated to intraoperative DEX sedation in a patient undergoing breast cancer surgery.Methods:A 42 years-old patient, ASA 2, was scheduled to undergo quadrantectomy with sentinel lymph node biopsy. Before surgery, we performed a US-ESPB and 20 ml of 0,5% Ropivacaine were injected using a 90 mm needle (Temena u00ae) deep to the erector spinae muscle and superficial to T5 transverse processes. The patient received intravenously DEX in a loading dose of 1 mcg/kg over 15 minutes, followed by an infusion of 0,4 mcg/kg/h and oxygen (4 l/min) was administered by facemask.Results:We obtained adequate surgical anesthesia and a good quality postoperative analgesia. Moreoverer, DEX infusion provided cooperative sedation during surgery (Ramsay 3) without causing respiratory depression of the patient. Only 3 g of acetaminophen were administered postoperatively. No complications were recorded.Conclusions:This case report suggested that US-ESPB associated to intraoperative DEX cooperative sedation could represent a reliable strategy for anesthetic management in breast surgery.
Book Synopsis THE ERECTOR SPINAE PLANE BLOCK FOR MULTIMODAL ANALGESIA AFTER LUNG LOBECTOMY AND RADIOLOGIC EVALUATION. by :
Download or read book THE ERECTOR SPINAE PLANE BLOCK FOR MULTIMODAL ANALGESIA AFTER LUNG LOBECTOMY AND RADIOLOGIC EVALUATION. written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The thoracic epidural block (TEB) and thoracic paravertebral block (TPVB) are the most commonly used techniques for analgesia after thoracic surgery.1-4 TEB has several adverse effects, such as hypotension, bradycardia, motor blockade, hematoma, and abscess.1, 2, 5, 6 TPVB has a chance of epidural spread, leading to hypotension and bradycardia.7 Multiple injections are needed if more than 4 dermatome analgesia is required.7 Additionally, it carries the risk of pleural puncture and pneumothorax. Neither TEB nor TPVB are technically easy. Recently, erector spinae plane block (ESPB) was reported as a treatment for thoracic neuropathic pain.8 ESPB is a relatively simple technique with easily identified sonographic landmarks, and a catheter is easily inserted into the plane after distention induced by the injection. ESPB anesthetizes both the ventral rami of spinal nerves and the rami communicants containing sympathetic nerve fibers, through spread into the thoracic paravertebral space.8 The ESPB thus has the potential to provide both somatic and visceral sensory blockade.9 We report a case of video-assisted thoracoscopic lobectomy in which continuous ESPB was used to provide highly effective analgesia, and the effect of ESPB was verified by radiologic evaluation in a living patient.
Book Synopsis Epidural Anesthesia in a Video-assisted Thoracoscopic Surgery (VATS) on an Awake Pneumonectomized Patient: a Case Report by : Abigail Villena
Download or read book Epidural Anesthesia in a Video-assisted Thoracoscopic Surgery (VATS) on an Awake Pneumonectomized Patient: a Case Report written by Abigail Villena and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Epidural anesthesia in a video-assisted thoracoscopic surgery (VATS) on an awake pneumonectomized patient: a case report.Villena A; Ferrando C; Navarro J; Belda FJ.BackgroundThe future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution looking for improvements to reduce the trauma to the patient. For these reasons we present this case where minimally invasive surgery was combined with the use of regional anesthesia.Case reportA 53 years old man, ASA III, ARISCAT 60 and Goldman II who was undergoing VATS for left pleural effussion drainage and lower lobe biopsy. Medical history of interest: right pleuro-pneumonectomy in 2008 due to malignant pleural mesothelioma with posterior radio/chemotherapy.Given the impossibility of carrying out selective right lung ventilation we decided to realize an awake anesthesia with an epidural blockade at T5-T6 level together with a continuous Dexmedetomidine infusion of 1 mcg/kg/h to maintan a BIS between 60 and 80. To achieve the desired analgesic level 3 bolus of a combination of Lidocaine 2% + Levobupivacaine 0.125% were administer: 8, 4 and 2 ml. The surgery lasted 1 hour. Hemodynamic stability was maintained during all the surgery (mean BP 110/71 mmHg and HR 75 bpm). The patient was oxygenation 0.28 FiO2 and SpO2 > 97% was maintaned during all the process. No incidents were reported during the surgery. After surgery, the epidural catheter was removed and the patient was transferred to the PACU for 12h. Discussion The present case shows an anesthetic alternative which can be used in special cases where selective ventilation is not allowed. We emphasize that this strategy may avoided the potential adverse effects related to general anaesthesia and selective ventilation, such as residual neuromuscular blockade postoperative nausea and vomiting and ventilation-induced lung injury. Finally, we accentuate treatment with dexmedetomidine to maintain a minimally and adequate sedation avoiding the adverse effects related to stress. Learning pointsThis anesthetic management might add a further step on the fast track surgery and become an indispensable and fully reliable tool within thoracic surgery.ReferenceGonzalez-Rivas D, Bonome C, Fieira E et al. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg 2015.
Book Synopsis ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK AS A POSTOPERATIVE ANALGESIA TECHNIQUE FOR THORACOSCOPY WITH TALC PLEURODESIS by : Rita Inu00e1cio
Download or read book ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK AS A POSTOPERATIVE ANALGESIA TECHNIQUE FOR THORACOSCOPY WITH TALC PLEURODESIS written by Rita Inu00e1cio and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:The erector spinae plane (ESP) block is a newly described and effective interfascial plane block for thoracic and abdominal surgery.It involves injection of local anesthetic between erector spinae muscles group and thoracic transverse processes. The site of injection is distant from the pleura, major blood vessels, and spinal cord. Therefore, compared to other techniques used for thoracic analgesia, as thoracic epidural, thoracic paravertebral, and intercostal blocks, ESP block is a much safer block with relatively few contraindications and easier to perform.Methods:We present the case of a 64-year-old male patient, ASA 2, scheduled for thoracoscopy with talc pleurodesis due to recurrent primary spontaneous pneumothorax. The procedure was performed under general anesthesia and went uneventful. During PACU recovery the patient presented moderate to severe pain (NRS pain score 7/10).We performed an ultrasound-guided ESP block at T5 level with 30 mL Ropivacaine 0.375% plus adrenaline 5 ug/mL. The block was administrated successfully with observation of the solution spread between transverse process and the erector spinae muscles.Results:After 30 minutes patient NRS pain score was 1/10 with no limitation of respiratory movements. Postoperative analgesia was complemented with paracetamol 1g plus ketorolac 30 mg tid. During the 48-hour hospital stay patient presented only mild pain (maximum NRS pain score of 2/10). No opioids were used and the patient reported a very high level of satisfaction.Conclusions:This relatively simple and safe block dramatically reduced the patient NRS pain score and IV pain medication needs, mainly opioids, optimizing respiratory function ant patient mobilization.
