Saudi journal of anaesthesia
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Erector spinae plane (ESP) block is a regional anesthesia technique, which provides visceral and somatic analgesia for abdominal surgery; during surgery and in the postoperative period. The local anesthetic is injected between the erector spinae muscle and the transverse process and it spreads cranially and caudally into the paravertebral space, affecting the ventral and dorsal branches of the thoracic spinal nerves and the rami communicants that contain sympathetic nerve fibers. ESP block can replace thoracic epidural anesthesia and has a better analgesic effect compared to other plane blocks that are used in abdominal surgery. We described six case series of successfully performed ESP block for postoperative analgesia in various abdominal surgeries such as unilateral open inguinal hernia repair with a supraumbilical hernia, ileostomy reversal surgery, open diaphragmatic hernia repair, laparoscopic cholecystectomy, and abdominal abscess evacuation.
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Case Reports
Erector spinae plane block and rhomboid intercostal block for the treatment of post-mastectomy pain syndrome.
Post-mastectomy pain syndrome (PMPS) can have multiple pain generators, including neuropathic pain and myofascial pain syndrome (MPS). Erector spinae plane (ESP) block and rhomboid intercostal block (RIB) have been used to provide anesthesia of the thorax and also for some chronic pain conditions. ⋯ The result was maintained 3 months later. This report suggests that ESP block and RIB with local anesthetic and corticosteroids with might be useful to treat a PMPS.
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Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed. ⋯ CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.
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Thoracic paravertebral block (TPVB) has become the gold standard to provide postoperative analgesia in breast surgery. Recently, ultrasound-guided (USG) pectoralis (PECS) block and serratus anterior plane (SAP) block have been described as an alternative to TPVB. The objectives were to compare TPVB, PECS, and SAP block in terms of analgesic efficacy and the spread of local anesthetic by ultrasound imaging, correlating it with the sensory blockade. ⋯ TPVB and SAP group result in a greater spread of the drug and provide equivalent analgesia and are superior to the PECS II block in providing analgesia for breast surgeries. SAP block is easier to perform than TPVB with lesser chances of complications and results in faster onset.
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Inadequate pain relief after thoracotomy may lead to postoperative respiratory complications. ⋯ SAP block with continuous catheter technique seems to be a safe and effective modality for the management of acute postoperative pain after thoracotomy.