Safe and Effective Use of Bilateral Erector Spinae Block in Patient Suffering from Post-operative Coagulopathy following Hepatectomy

Abstract

Unusual clinical course Background:Regional nerve blocks ideally provide safe and effective post-operative pain control, decrease opiate requirements, and enhance recovery from intense pain following major thoracic, abdominal, and musculoskeletal surgeries. The erector spinae plane block, a recently described novel treatment for chronic neuropathic pain and acute pain after thoracic surgery, can be performed with in plane infiltration and placement of a continuous infusion catheter deep to the erector spinae muscle at the tip of the transverse process, resulting in diffusion of local anesthetic between vertebrae and the paravertebral space with sensory blockade of spinal nerves as well as sympathetic branches. Case Report:We describe the novel use of the erector spinae block for primary pain control and uncomplicated catheter removal in the setting of anticoagulation following a major hepatectomy for intrahepatic cholangiocarcinoma. The use of the erector spinae block in this context provided effective post-operative analgesia. Conclusions:Additional evidence from clinical trials will be helpful to evaluate the role of this relatively new block for perioperative analgesia.

Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial

“…Maddineni et al 17 reported a successful outcome of ESP as a replacement for gold standard epidural analgesia in achieving effective pain control following hepatic surgery. Similarly, a study by Gürkan 18 has shown that US-guided ESP block and PVB provided adequate analgesia in patients undergoing breast surgery and have an opioid sparing effect by reducing morphine consumption.…”

Comparison of Continuous Thoracic Epidural With Erector Spinae Block for Postoperative Analgesia in Adult Living Donor Hepatectomy

“…This has been described in two studies, which narrate that the ESPB is a safer option in the presence of systemic anticoagulation, use of antiplatelet medications, coagulation disorders, and following heparinization, which are contraindications to TEA [ 19 , 20 ]. Maddineni et al also described the novel use of the ESPB for analgesia and safe catheter removal in the setting of anticoagulation undergoing major hepatic surgery for intrahepatic cholangiocarcinoma [ 21 ]. Therefore, ESPB seems much safer than TEA after donor hepatectomy in the presence of decreased platelets and increased INR.…”

Erector spinae plane block: a new modality of pain relief in a difficult situation

“…We introduced the catheters preoperatively to reduce the stress response during surgery. We found that the patient remained hemodynamically stable in contrast to a continuous epidural infusion in which frequent episodes of hypotension are often encountered [ 3 , 4 ]. He did not require additional doses of fentanyl intraoperatively after the initial dose at induction.…”

“…The use of bilateral continuous block ensured ongoing pain relief [ 2 ]. There is a lack of consensus on the type, dose, and concentration of local anesthetic for this block [ 3 ]. We used ropivacaine 0.2% with fentanyl 2 μg/ml at the rate of 7 ml/h, which provided adequate analgesia.…”

“…ESP block is also believed to have an antiemetic effect, which is advantageous in gastrointestinal surgery [ 2 ]. Although ESP block has been used extensively in thoracic, cardiac, and laparoscopic surgery, there are very few reports on its use in upper abdominal surgery [ 3 – 5 ].…”