Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in...Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.展开更多
Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks...Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.展开更多
文摘Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.
文摘Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.
