Gopinath Bharath, Nayaka Rakesh, Kuruvila Rachel, Bhoi Sanjeev
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Emerg Med. 2022 Mar;62(3):393-396. doi: 10.1016/j.jemermed.2021.11.012. Epub 2022 Jan 20.
Acute pain management in the emergency department (ED) is a challenging task, more so in pain due to malignancy. Opioids have life-threatening side effects in ED patients, along with the risk of dependency. Erector spinae plane block (ESPB) is a recently described plane block technique with ease of performance and minimal side effects, making it suitable for emergency settings.
A 62-year-old male patient recently diagnosed with cholangiocarcinoma presented to the ED with severe right upper abdominal pain. There was no pain relief with high doses of analgesics. ESPB was administered at T7 vertebrae level. The patient's Defense and Veteran Pain Rating Scale score reduced from 8/10 pre-procedure to 3/10 within 15 min, and 2/10 1 h after the procedure. He reported that he had an uninterrupted pain-free sleep after 4 days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ESPB is a novel regional analgesia that may help in management of uncontrolled severe pain not relieved with analgesics in patients with cholangiocarcinoma in the ED.
急诊科的急性疼痛管理是一项具有挑战性的任务，对于恶性肿瘤引起的疼痛更是如此。阿片类药物对急诊科患者有危及生命的副作用，同时存在成瘾风险。竖脊肌平面阻滞（ESPB）是一种最近描述的平面阻滞技术，操作简便且副作用最小，适用于急诊情况。
一名62岁男性患者，近期被诊断为胆管癌，因右上腹剧痛就诊于急诊科。高剂量镇痛药未能缓解疼痛。在T7椎体水平实施了ESPB。患者的国防和退伍军人疼痛评定量表评分从术前的8/10降至15分钟内的3/10，术后1小时为2/10。他报告称4天后有了无间断的无痛睡眠。急诊医生为何应了解此情况？：ESPB是一种新型区域镇痛方法，可能有助于管理急诊科中胆管癌患者使用镇痛药无法缓解的失控性剧痛。
