Klesius L, Schroeder K
Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA.
Case Rep Anesthesiol. 2019 Apr 8;2019:9159878. doi: 10.1155/2019/9159878. eCollection 2019.
Pain management in trauma patients with acute rib and spine fractures presents a challenge for the anesthesiologist and achieving adequate analgesia is important in preventing pulmonary complications. Unfortunately, neuraxial techniques are often challenging or contraindicated due to spine fractures or coagulopathy. Erector spinae plane (ESP) blocks provide an alternative regional anesthetic technique to manage pain. We describe a case of bilateral ESP catheters placed intraoperatively after spinal instrumentation in a patient with bilateral rib and spine fractures sustained in a tractor rollover crash. Prior to surgery, the patient had inadequate pain control and poor respiratory function despite multimodal analgesia. With the addition of bilateral ESP catheters, the patient's pain control improved and he was weaned from respiratory support. ESP blocks have been shown to provide effective analgesia in patients with rib fractures; however, the utilization of these blocks has not been described in patients with spine fractures undergoing spinal instrumentation. Thus, ESP blocks provide a simple alternative to providing surgical and trauma analgesia when neuraxial techniques are contraindicated. The success of bilateral ESP catheters in our patient indicates a further area for application of ESP blocks in patients undergoing spine surgery with acute traumatic spine fractures.
对于患有急性肋骨和脊柱骨折的创伤患者，疼痛管理对麻醉医生来说是一项挑战，实现充分镇痛对于预防肺部并发症很重要。不幸的是，由于脊柱骨折或凝血功能障碍，神经轴技术往往具有挑战性或属于禁忌。竖脊肌平面（ESP）阻滞提供了一种用于管理疼痛的替代性区域麻醉技术。我们描述了一例在拖拉机翻车事故中双侧肋骨和脊柱骨折的患者，在脊柱内固定术后术中放置双侧ESP导管的病例。术前，尽管采用了多模式镇痛，患者的疼痛控制仍不佳且呼吸功能较差。通过增加双侧ESP导管，患者的疼痛控制得到改善，并成功脱机。ESP阻滞已被证明能为肋骨骨折患者提供有效的镇痛；然而，在接受脊柱内固定手术的脊柱骨折患者中，尚未有使用这些阻滞的相关描述。因此，当神经轴技术禁忌时，ESP阻滞为手术和创伤镇痛提供了一种简单的替代方法。我们患者中双侧ESP导管的成功应用表明，ESP阻滞在急性创伤性脊柱骨折的脊柱手术患者中还有进一步的应用领域。
