Selvi Onur, Tulgar Serkan, Ozer Zeliha
Aneasthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR.
Anaesthesiology, Maltepe University Faculty of Medicine, Istanbul, TUR.
Cureus. 2018 Nov 3;10(11):e3538. doi: 10.7759/cureus.3538.
Erector spinae block (ESPB) is an effective therapy for chronic shoulder pain. However, ESPB has not been used as a postoperative analgesia method in shoulder surgeries. In this case report, we report three patients undergoing shoulder surgeries that received ESPB preoperatively for postoperative analgesia. All patients had relief of preoperative pain and no associated motor block. Two of the patients manifested with low maximum pain scores (4/10, 3/10) on a numeric rating scale (NRS). The other patient reported a maximum pain score of 8/10 on NRS. While this patient's shoulder mobility immediately improved after ESPB application, the ESPB did not provide adequate analgesia for the postoperative period. The use of the ESPB for acute postoperative analgesia after shoulder surgery is novel and clinically interesting. However, postoperative analgesia was not completely opioid-sparing. Consequently, the efficiency of ESPB at the level of T2 for postoperative analgesia should be considered for surgeries that involve the shoulder cap given the possible inadequate migration of local anesthetic into the cervical plexus. Clinicians should carefully consider an ESPB as a postoperative analgesic option when considering shoulder operations and the possibility for the incomplete spread of local anesthetic in targeted neural structures.
竖脊肌平面阻滞（ESPB）是治疗慢性肩部疼痛的一种有效方法。然而，ESPB尚未被用作肩部手术的术后镇痛方法。在本病例报告中，我们报告了3例接受肩部手术的患者，他们术前接受了ESPB用于术后镇痛。所有患者术前疼痛均得到缓解，且未出现相关运动阻滞。其中2例患者在数字评分量表（NRS）上的最大疼痛评分较低（4/10，3/10）。另1例患者报告NRS最大疼痛评分为8/10。虽然该患者在应用ESPB后肩部活动度立即改善，但ESPB在术后并未提供足够的镇痛效果。将ESPB用于肩部手术后的急性术后镇痛是新颖且具有临床意义的。然而，术后镇痛并未完全避免使用阿片类药物。因此，对于涉及肩胛的手术，考虑到局部麻醉药可能无法充分向颈丛扩散，应考虑T2水平的ESPB用于术后镇痛的效果。临床医生在考虑肩部手术以及局部麻醉药在目标神经结构中扩散不完全的可能性时，应谨慎考虑将ESPB作为术后镇痛的选择。
