Use of the bilateral erector spinae (ESP) block for postoperative analgesia following the removal of the Nuss bar: case report

  • Ana Eugenia Herrera-Mora Hospital San Juan de Dios, San José, Costa Rica.
  • Viviana Mojica-Manrique Fundación Santa Fé, Bogotá, Colombia.
  • Mauricio Salas-González Hospital San Juan de Dios, San José, Costa Rica.
Keywords: Funnel Chest, Nerve Block, Pain, Postoperative, Paraspinal Muscles, Anesthetics, Local

Abstract

Introduction:

The erector spinae plane (ESP) block is a relatively new interfascial block about which several applications have been described, both in abdominal and thoracic surgical procedures.

Case presentation:

A 17-year old patient programed for removal of a Nuss bar through mini-thoracotomy. Following the induction with anesthesia, a US-guided bilateral ESP block was administered; no pain was reported during the immediate postoperative period and over the 48-hour follow-up.

Conclusion:

Bilateral ESP block seems to be promising, easy to administer, and an acceptable alternative to the epidural catheter (the gold standard in the management of analgesia for thoracic surgery), providing adequate and opiate-free analgesia.

References

1. Forero M, Adhikary SD, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621-627.

2. Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery. A report of 3 cases. Reg Anesth Pain Med 2017;42:372-437.

3. Varela P. Pectus excavatum: history, and new proposals for diagnosis and treatment. Rev Med Clin Condes 2009;20:769-775.

4. Nuss D, Kelly R, Croitoru D, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998;33:545-552.

5. Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg 2016;5:422-433.

6. Park HJ, Kim KS. Pectus bar removal: surgical technique and strategy to avoid complications. J Vis Surg 2016;2:60.

7. Nyboe C, Knudsen M, Pilegaard H. Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience. Eur J Cardiothorac Surg 2011;39:1040-1042.

8. Shah SB, Hariharan U, Bhargava AK, et al. Anesthesia for minimally invasive chest wall reconstructive surgeries: our experience and review of literature. Saudi J Anaesth 2017; 11:319-326.

9. Ladenhauf HN, Stundner O, Likar R, et al. Successful treatment of persistent pain after pectus excavatum repair using paravertebral nerve radiofrequency thermoablation. A A Case Rep 2017;8:18-20.

10. Nardiello MA, Herlitz M. Bilateral single shot erector spinae plane block for pectus excavatum and pectus carinatum surgery in 2 pediatric patients. Rev Esp Anestesiol Reanim 2018;65:530-533.

11. Sánchez N, Lima J, Selman E, et al. Anesthetic management of pediatric patients with pectus excavatum. Rev Cuba Anestesiol Reanim 2012;11:230-236.

12. Patvardhan C. Anaesthetic considerations for pectus repair surgery. Review article on thoracic surgery. J Vis Surg 2016;2:76.

13. Soliman IE, Apuya JS, Fertal KM. Intravenous versus epidural analgesia after surgical repair of pectus excavatum. Am J Ther 2009;16:398-403.

14. Densmore J, Peterson D, Stahovic LL, et al. Initial surgical and pain management outcomes after Nuss procedure. J Pediatr Surg 2010;45:1767-1771.

15. Muhly WT, Maxwell LG, Cravero JP. Pain management following the Nuss procedure: a survey of practice and review. Acta Anaesthesiol Scand 2014;58:1134-1139.

16. Kolvekar S, Pilegaard H, Ashley E, et al. Pain management using patient controlled anaesthesia in adults post Nuss procedure: an analysis with respect to patient satisfaction. J Vis Surg 2016;2:37.

17. Reinoso-Barbero F, Fernández A, Durán P, et al. Thoracic epidural analgesia vs patient-controlled analgesia with intravenous fentanyl in children treated for pectus excavatum with the Nuss procedure. Rev Esp Anestesiol Reanim 2010;57:199-263.

18. López-GarcíaJC, Castejón J, Moreno M, et al. Anestesia multimodal infantil: analgesia epidural. Rev Soc Esp Dolor 2004;7:204.

19. Singhal N, Jones J, Semenova J, et al. Multimodal anesthesia with the addition of methadone is superior to epidural analgesia: a retrospective comparison of intraoperative anesthetic techniques and pain management for 124 pediatric patients undergoing the Nuss procedure. J Pediatr Surg 2016;51:612-616.

20. Manworren R, Anderson M, Girard ED, et al. Postoperative pain outcomes after Nuss procedures: comparison of epidural analgesia, continuous infusion of local anesthetic, and preoperative self-hypnosis training. J Laparoendosc Adv Surg Tech A 2018;2:1-9.

21. Kabagambe SK, Goodman LF, Chen YJ, et al. Subcutaneous local anesthetic infusion could eliminate use ofepidural analgesia after the Nuss procedure. Pain Manag 2018;8:9-13.
How to Cite
1.
Herrera-Mora AE, Mojica-Manrique V, Salas-González M. Use of the bilateral erector spinae (ESP) block for postoperative analgesia following the removal of the Nuss bar: case report. Colomb. J. Anesthesiol. [Internet]. 2019Jul.1 [cited 2021Oct.16];47(3):184-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/82

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Published
2019-07-01
How to Cite
1.
Herrera-Mora AE, Mojica-Manrique V, Salas-González M. Use of the bilateral erector spinae (ESP) block for postoperative analgesia following the removal of the Nuss bar: case report. Colomb. J. Anesthesiol. [Internet]. 2019Jul.1 [cited 2021Oct.16];47(3):184-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/82
Section
Case Report / Case Series

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