The erector spinae plane (ESP) block is a novel interfascial regional analgesic technique that was described by Forero et al. [1] in 2016, to treat thoracic neuropathic pain. Growing evidence of its efficacy and relative simplicity of performance has resulted in an increase in its use for managing acute and chronic pain [2-5]. The spread of local anesthetic through the paravertebral spaces is thought to be responsible for its analgesic effect on somatic and visceral pain, and thus, it has been reported to be as effective as thoracic epidural analgesia when administered bilaterally [6]. The ESP block may have some advantages over thoracic epidural analgesia, as it is a moderately simple technique that can be used unilaterally. It provides lesser sympathetic blockade with fewer cardiovascular effects, compared to the paravertebral block. However, the administration of the ESP block requires ultrasonographic guidance. The ESP block seems to be similar to a superficial block compared to the epidural and paravertebral blocks, with a lower risk of hemorrhage, especially in patients with altered hemostasis, i.e., the risk of spinal hematoma and spinal cord compression is lower, as the block is administered superficial to the transverse processes, allowing the spinal cord to be protected by the vertebral canal. However, these aspects have not been studied in depth and established firmly in current literature [7]. We describe a case series of 5 patients with altered hemostasis (activated partial thromboplastin time [aPTT] ratio or internatinal normalized ratio [INR] exceeding 1.5 times the normal value, a platelet count equal to or below 80000/μl, or use of anticoagulant Background: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis. Case: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/μl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days. Conclusions: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.

No abstract

Introduction: In the current century, increasing importance has been given to the opinions, expectations and experiences of women using healthcare services. The fulfillment of expectations is determined by satisfaction. This study aims to analyze both expectations and satisfaction during childbirth regarding labor epidural analgesia among parturients, with a focus on myths.Material and Methods: A prospective observational study was conducted in parturients at the Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital in Lisbon, Portugal, applying a questionnaire to 317 random women. SPSS v22.0 was used for data analysis.Results: Three hundred questionnaires were returned, from women with a mean age of 31. Among the respondents, 46.3% had a college degree and 64% were employed, 46% were primiparas and only 14% had a previous anesthesiology appointment for childbirth purposes. The overall degree of satisfaction surrounding the birth experience was good/excellent for 87% of women. Labor epidural analgesia was performed on 96% of all patients, with an excellent/good outcome for 82.1% and a higher than expected results for 40.7% of them. Regarding the myths, 52.5% believed that epidural analgesia imposes a dose limit and 58.9% that it often causes permanent back pain. The level of education was significantly associated with some myths (p < 0.05), since women with a higher level of education do not believe most of them.Discussion: This study supports the need for an evaluation of the current information that women have about labor epidural analgesia/childbirth. Women’s individual needs can be met by multidisciplinary teams including Anesthesiology specialists.Conclusion: Maternal satisfaction with childbirth and analgesia is a complex and dynamic process that includes and is not limited to the relief of pain.

No abstract

Aim: This case report presents the application of ultrasound-guided hydrodissection of the superficial peroneal nerve to treat chronic refractory neuropathic pain, rated by the patient with an average intensity of 6/10 on the numerical rating scale. Materials & methods: Under ultrasound guidance, the nerve was identified compressed by a herniation of the peroneus brevis. An in-plane hydrodissection was performed using a solution of 10 ml of ropivacaine and methylprednisolone until the epineurium was entirely separated from the surrounding tissue. Results: At the 2-month follow-up, the patient reported a decrease of pain, which he rated a 2/10 on the numerical rating scale. At this point, night-time episodes of moderate pain persisted. The procedure was repeated and at the 6-month follow-up, the patient remained pain free. Conclusion: This case report suggests that consecutive ultrasound-guided hydrodissection techniques might be a valuable option in the treatment of superficial peroneal nerve entrapment neuropathy.