1Department of Anesthesiology, MacKay Memorial Hospital, Taipei, Taiwan
2Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
3MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
Outline
Background
Erector spinae plane block is an innovative inter-fascial plane block featuring the alike effects of paravertebral block, less technically challenging to perform, less complications and not absolutely contraindicated in patients with coagulopathy.
Case presentation
A 1-year-7-month-old, 11 kg boy was diagnosed with a huge hepatoblastoma. After the chemotherapy, he was undergoing S4b and S5 segmental hepatectomy. Multimodal analgesia includes intraoperative remifentanil infusion, propacetamol, fentanyl and right-side erector spinae plane block. At left lateral decubitus position, a linear ultrasound probe was placed lateral to the T8 spinous process in a sagittal paramedian orientation for erector spinae plane block needling. After negative aspiration of heme, a total of 6 ml 0.33% ropivacaine was administrated. As the inter-facial space enlarged upward but not downward, he received additional 2 ml of 0.33% ropivacaine at ipsilateral T9 level to reinforce the effect. Endotracheal tube was removed smoothly after surgery and transferred him to the post-anesthesia care unit with clear consciousness and total pain relief (FLACC scale: 0).
Discussion
Single-shot thoracic erector spinae plane block with multimodal analgesia strategy had a good pain relief in this case, who could smoothly extubate after hepatectomy. Erector spinae plane block with catheter indwelling could be considered to extent postoperative analgesia duration.
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