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Erector spinae block: 'new kids on the block' for simple mastectomy
Author(s): ,
Magalhães, J.*
Affiliations:
Hospital Senhora Oliveira - Guimarães, Anestesiologia, Guimarães, Portugal
,
Jesus, T.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
,
Antunes, C.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
,
Ferreira, S.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
,
Coutinho, A.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
,
Machado, C.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
Rodrigues, S.
Affiliations:
Hospital Senhora da Oliveira, Anesthesiology, Guimarães, Portugal
ESRA Academy. Marinho Magalhaes J. Sep 13, 2017; 190949
Topic: Breast surgery
Dr. Joana Maria Marinho Magalhaes
Dr. Joana Maria Marinho Magalhaes

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Abstract
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Background and Aims:

 Erector spinae block (ESP) was first described in 2016 by Forero, as a valid alternative for thoracic analgesia. The authors described two cases of simple mastectomy under general anesthesia combined with ESP block.


 

 

 

 

 

 

 



Methods:

Patient 1: female, 65 years old; healthy.

Patient 2: male, 72 years old. High blood pressure.

Technique

Before performing the block, the patient was in the sitting position, under midazolam 1mg and fentanyl 0,05 mg. The T7 level was identified by palpation of inferior angle of the scapulae and, then,T4 level under ultrasound control (image1).The same anesthesiologist perform the ultrasound guided ESP block, using a parassagital approach, linear probe and 50 mm needle and in plane approach, from cephalic to caudal, until T4 transverse process was felt. Afterwards, was injected 20 mL of 0,375% ropivacaine (LA) under the erector spinae muscle (image 2 and 3).In the second patient was used epinephrine 5mcg/mL, mixed with LA.After performing the ultrasound guided block, in both patient a laringeal mask airway was placed under general anesthesia.

Results:

Both patients had an effective analgesia under ESP block. Pt 1, 35 min after block, became bradicardic (38 bpm) and pt 2 had an transitory increase in the heart rate(>30%baseline)immediately after injection of LA plus epinephrine

Conclusions:

Despite only applied in two patients,the ESP block reveals a good analgesia profile, easy and safe technique.The authors also confirm a similar profile to the paravertebral block, however with an extensive block and safer technique.It will be considered a good practice using concomitant dose test due to proximity of intercostal area.


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