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Erector Spinae Plane Block in Paediatric Thoracic Surgery
Author(s): ,
Regufe, R.*
Affiliations:
Centro Hospitalar Setubal, Anaesthesiology, Setubal, Portugal
,
Veiga, M.
Affiliations:
Hospital Central do Funchal, Anaesthesiology, Funchal, Portugal
,
Trindade, H.
Affiliations:
Centro Hospitalar Lisboa Central, Anaesthesiology, Lisbon, Portugal
,
Lobo, C.
Affiliations:
Hospital Militar Regional No1- Polo do Porto, Anaesthesiology, Porto, Portugal
Ferreira, J.L.
Affiliations:
Centro Hospitalar Lisboa Central, Anaesthesiology, Lisbon, Portugal
ESRA Academy. Regufe R. Sep 13, 2017; 190836; 522 Topic: Paediatric Population
Disclosure(s): Nothing to disclose
Dr. Rita Regufe
Dr. Rita Regufe

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Abstract
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Background and Aims:

Managing pain after thoracic surgery is challenging, with several options available, each with limitations. The erector spinae plane block (ESPB) is a recent analgesic approach for thoracic pain. We report a case of ESPB for paediatric thoracic surgery.

Methods:

A 1 y-o female, 10kg, ASA I, proposed for urgent video-assisted (VATS) decortication due to sequelae of pneumonia on the right. After induction and intubation, the patient was positioned in left lateral decubitus and a high frequency linear ultrasound transducer was placed longitudinal, parasagittal to T3-T5 spinous processes. After identifying the muscle layers superficial to the deepest: trapezius, rhomboid major and erector spinae, 3ml of Ropivacaine 0,2% were injected in the interfascial plane between rhomboid major and erector spinae. During the surgery paracetamol and ketorolac were administered. The patient was extubated and in the post-operative had a maximum FLACC scale of 2 in 24 hours with paracetamol each 6 hours.

Results:

The ESPB has been described in adults, with two forms of injection: between rhomboid major and erector spinae and between the latter and the transverse process, both achieving an area of analgesia ranging intercostal innervation from T2-T9. VATS is less invasive, nevertheless effective analgesia is needed in the immediate post-operative period for a better pulmonary excursion. This fascial block seemed like a reasonable choice for this surgery and proved to be effective in the hours that followed.

Conclusions:

ESPB may be effective in managing acute post-operative pain in thoracoscopic pediatric surgery, bypassing some risks and limitations associated with deeper blocks or neuraxial analgesia.

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