Petsas Dimosthenis, Pogiatzi Valentini, Galatidis Thanasis, Drogouti Maria, Sofianou Iliana, Michail Alexis, Chatzis Iosif, Donas Georgios
Anesthesiology Department, Agios Dimitrios Hospital, Thessaloniki, Greece,
Department of Anesthesiology Nursing, Agios Dimitrios Hospital, Thessaloniki, Greece.
J Pain Res. 2018 Sep 24;11:1983-1990. doi: 10.2147/JPR.S164489. eCollection 2018.
The Erector Spinae Plane Block (ESP) is a novel regional technique for anesthesia or analgesia. Originally the ESP block was described in 2016 in a case report regarding analgesia intervention for a case of thoracic neuropathic pain. Since then, there has been growing interest and research adding experience about the ESP block as regional anesthetic and analgesic technique. Reviewing the literature about this novel technique in databases like PubMed using the key words "erector spinae plane block" returns approximately 56 publications. So far there is no available big series of cases or reviews regarding the ESP block. The literature is limited to case reports or case series. With the present case we are interested in exploring the efficacy of ESP block as a postoperative analgesic method for laparoscopic cholecystectomy. We describe the case of a 76-year-old female patient scheduled for laparoscopic cholecystectomy. Written informed consent was granted (for procedure and publication of photos). We applied a bilateral ultrasound-guided ESP block at T level while the patient was awake before general anesthesia induction. The anesthetic solution we used consisted of 12 mL Ropivacaine 0.375% plus 2 mg dexamethasone (on each side). After the successful administration of the block (observation of the solution spread between transverse process and the erector spinae muscles), general anesthesia was induced and the procedure was started. Procedure and recovery was uneventful with the patient experiencing very good analgesia (NRS pain score 0 up to 6 hours after block placement). The patient presented mild pain (NRS score of 2-3) after 6 hours and requested the "on demand" pain medication (1 g paracetamol IV) only 10 hours after the ESP block (NRS pain score of 4-5). The patient experienced no nausea or vomiting, was mobilized easily about 6 hours after the block and was discharged the next day. This relatively simple and safe block dramatically reduced the amount of IV pain medication we usually administer for the specific procedure. The overall result was increased satisfaction of the patient and avoidance of opioid use.
竖脊肌平面阻滞（ESP）是一种用于麻醉或镇痛的新型区域技术。最初，ESP阻滞于2016年在一篇关于胸段神经性疼痛镇痛干预的病例报告中被描述。从那时起，人们对ESP阻滞作为区域麻醉和镇痛技术的兴趣与研究不断增加，并积累了更多经验。在PubMed等数据库中使用关键词“竖脊肌平面阻滞”检索关于这项新技术的文献，约有56篇出版物。到目前为止，尚无关于ESP阻滞的大量病例系列或综述。相关文献仅限于病例报告或病例系列。通过本病例，我们旨在探讨ESP阻滞作为腹腔镜胆囊切除术后镇痛方法的疗效。我们描述了一名计划接受腹腔镜胆囊切除术的76岁女性患者病例。患者签署了书面知情同意书（包括手术及照片发表）。在全身麻醉诱导前患者清醒状态下，于T水平实施双侧超声引导下的ESP阻滞。我们使用的麻醉溶液为每侧12 mL 0.375%罗哌卡因加2 mg地塞米松。成功实施阻滞后（观察溶液在横突与竖脊肌之间扩散），诱导全身麻醉并开始手术。手术及恢复过程顺利，患者镇痛效果良好（阻滞后6小时内数字评分法[NRS]疼痛评分0分）。6小时后患者出现轻度疼痛（NRS评分为2 - 3分），仅在ESP阻滞后10小时要求使用“按需”镇痛药物（静脉注射1 g对乙酰氨基酚）（NRS疼痛评分为4 - 5分）。患者未出现恶心或呕吐，阻滞后约6小时可轻松活动，次日出院。这种相对简单且安全的阻滞显著减少了我们通常为该特定手术使用的静脉镇痛药物用量。总体结果是提高了患者满意度并避免了阿片类药物的使用。
