Two-level bilateral ultrasound-guided erector spinae plane block for kyphosis corrective surgery - A case report -

Abstract

Background: Ultrasound-guided erector spinae plane (ESP) block has been used to provide lumbar analgesia. The craniocaudal spread of local anesthetic in this block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread. Case: This is a case of a 33-year-old male (60 kg) diagnosed with type 3b kyphosis of the thoracolumbar region at the level of L1 who underwent extended pedicle subtraction osteotomy. ESP block was administered at two different levels, one at T12 (above the angle of the kyphosis L1) and another at L3 (below the angle of kyphosis L1), as the curvature of kyphosis can hinder the longitudinal spread of local anesthetic. Conclusions: Two-level ESP block results in better craniocaudal spread of local anesthetic in a patient undergoing kyphosis correction surgery.

Comparison of the feasibility and validity of a one-level and a two-level erector spinae plane block combined with general anesthesia for patients undergoing lumbar surgery

“…The result showed that the twolevel ESP block provided a better pain sensorial blockage. Similar to our study, Silnha et al (24) found that the two-level ESP block resulted in a better cranio-caudal spread of LA in a patient undergoing kyphosis correction surgery. The spread of LA after the ESP block may follow different pathways, such as between the transverse process and the erector spinae muscle, between the QL muscle and the psoas muscle, and between the QL and the erector spinae muscle, which could block both the ventral and the dorsal rami of the spinal nerve (25).…”

Erector spinae plane block in spine surgeries: Single-level versus bi-level, single-shot versus continuous catheter technique

“…[ 9 ] Another case report of a patient who underwent kyphosis correction observed low pain scores until 48 hours for whom ESPB was performed at T12 and L3 (above and below the angle of kyphosis respectively). [ 10 ] Based on these reports, bi-level ESPB would be a better option if the surgery involves multiple levels. This is especially true in the background of the “cranio-caudad spread” of the injectate after ESPB being highly variable[ 6 ] as mentioned earlier.…”