An Exceptional Indication for Bilateral Thoracic Paravertebral Block Performance in a Pediatric Patient

Abstract

Paravertebral blocks (PVBs) have been previously reported for various surgical procedures in pediatric patients. [1][2][3][4][5] Recently, ultrasound-guided PVBs and catheter replacement techniques have also been used effectively for pain relief after thoracic, cardiac and abdominal surgeries as an alternative to epidural analgesia in pediatric patients. [6][7][8][9] We report a 10-year-old male patient (30 kg, 140 cm, ASA I) who underwent left latissimus dorsi muscle transfer (free flap) surgery under general anesthesia (GA) because of biceps brachii muscle motor weakness and atrophy occurring after oral (OPV) and inactive polio (IPV) vaccination (Figure 1). A decision was made to perform thoracic PVBs (TPVBs) bilaterally after surgery for postoperative pain management. With the patient in the right lateral decubitus position, a 10 MHz high-frequency linear transducer (GE LOGIQ book XP, GE Healthcare, Milwaukee, WI) was placed approximately 2-2.5 cm lateral to the tips of the spinous processes. Sonography demonstrated the consecutive transverse processes and pleura in between. The two level TPVBs was performed using the out-of-plane technique, aiming to block the dermatomes between T2 and T8 on the left side. After negative aspiration, a total of 20 ml of 0.125% bupivacaine was divided equally and deposited in paravertebral spaces of T3-T4 and T6-T7 while observing the pleura being moved downwards (Figure 2). Then, with the patient in the left lateral decubitus position, the same technique was used to perform a level T1 TPVBs to provide analgesia for levels C6-T2. Ten ml of 0.25% bupivacaine was injected and a 20-gauge catheter was placed to provide vasodilation of the free flap vascular anastomosis in addition to effective pain control. The catheter was then connected to an

Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient

“…1 However, options for surgery on the posterior thoracic wall have until now been limited to thoracic epidural or paravertebral blocks. 2 The erector spinae plane (ESP) block is a novel technique that anesthetizes the dorsal rami of spinal nerve roots and thus the branches innervating the posterolateral thorax. 3 There is only 1 report to date of its use for surgery of the posterolateral thorax in children.…”