Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
BMJ Case Rep. 2020 Sep 7;13(9):e234480. doi: 10.1136/bcr-2020-234480.
Ensuring respiratory stability with early tracheal extubation and adequate pain control is challenging in premature neonates after thoracotomy. Continuous erector spinae plane (ESP) block, a relatively new truncal nerve block, has the potential to provide analgesia for thoracic surgeries while reducing opioid use. However, there have been only a few reports utilising this technique in infants, and none in preterm neonates. We present the perioperative pain management of a preterm neonate requiring thoracotomy. Epidural analgesia was deemed contraindicated due to coexisting coagulopathy; therefore, an ESP catheter was placed. The patient was extubated at the end of the surgery and had excellent pain control with rectal acetaminophen, chloroprocaine infusion via the ESP catheter and with minimal opioid requirement. Continuous ESP block may be safe and effective for postoperative pain management in coagulopathic premature neonates. Chloroprocaine is an effective local anaesthetic in the erector spinae compartment, which has not been previously reported.
在剖胸术后的早产儿中，早期气管拔管和充分的疼痛控制以确保呼吸稳定具有挑战性。连续竖脊肌平面（ESP）阻滞是一种相对较新的躯干神经阻滞技术，有可能在提供胸部手术镇痛的同时减少阿片类药物的使用。然而，只有少数关于该技术在婴儿中应用的报道，在早产儿中则没有。我们介绍了一例需要剖胸术的早产儿的围手术期疼痛管理。由于同时存在凝血功能障碍，硬膜外镇痛被认为是禁忌的；因此，放置了 ESP 导管。患者在手术结束时拔管，术后通过直肠对乙酰氨基酚、ESP 导管输注氯普鲁卡因和最小剂量的阿片类药物，疼痛得到了很好的控制。对于凝血功能障碍的早产儿，连续 ESP 阻滞可能是一种安全有效的术后疼痛管理方法。氯普鲁卡因是竖脊肌间隙中的一种有效局部麻醉剂，以前没有报道过。
