Continuous erector spinae plane block for pain management in laparoscopic liver resection: case report
Pain after liver resection can be difficult to manage. Epidural anesthesia (EA) isaneffective technique inpain control inthis surgery.
However, postoperative coagulopathy and hypotension due to autonomic nervous system block in high-risk patients, may result that the EA is an inadequate analgesic technique in according to enhanced recovery after surgery (ERAS) recommendations for liver surgery.
Regional block techniques have been recommended for liver surgery in ERAS guidelines.
Erector spinae plane (ESP) block is a recent block described for thoracic and abdominal surgeries and provides both somatic and visceral analgesia.
We describe a high-risk patient with cardiac dysfunction and Parkinson’s disease who underwent laparoscopic right liver resection for hepatocellular carcinoma.
Satisfactory intra and postoperative analgesia was achieved by a combined continuous ESP block, transversus abdominis plane (TAP), and oblique subcostal TAP blocks.
Surgery and postoperative period was uneventful. No opioids were administered during hospitalization.
A combined of thoracic and abdominal wall blocks can be an effective approach for intra and postoperative analgesia in highrisk patients undergoing laparoscopic liver resection.
Further clinical research is recommended to establish the effectiveness of the ESP block as an analgesic technique in this surgery.
2. 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 2017;41:621–627.
3. 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;42:372–376.
4. Hebbard P. Subcostal transversus abdominis plane block under ultrasound guidance. Anesth Analg 2008;106:674–675.
5. Restrepo-Garces CE, Chin KJ, Suarez P, et al. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery. A Case Rep 2017;9:319–321.
6. Ueshima H, Otake H. Erector spinae plane block provides effective pain management during pneumothorax surgery. J Clin Anesth 2017;40:74.
7. Bonvicini D, Tagliapietra L, Giacomazzi A, et al. Bilateral ultrasound-guided erector spinae plane blocks in breast cancer and reconstruction surgery. J Clin Anesth 2017;44:3–4.
8. Aponte A, Sala-Blanch X, Prats-Galino A, et al. Anatomical evaluation of the extent of spread in the erector spinae plane block: a cadaveric study. Can J Anaesth 2019;66:886–893.
9. Tulgar S, Selvi O, Kapakli MS. Erector spinae plane block for different laparoscopic abdominal surgeries: case series. Case Rep Anesthesiol 2018;2018:3947281.
10. Niraj G, Zubair T. Continuous erector spinae plane (ESP) analgesia in different open abdominal surgical procedures: a case series. J Anesth Surg 2018;5:57–60.
11. Tulgar S, Selvi O, Senturk O, et al. Ultrasound-guided erector spinae plane block: indications, complications, and effects on acute and chronic pain based on a single-center experience. Cureus 2019;11:e3815.
12. Sforza M, Andjelkov K, Zaccheddu R, et al. Transversus abdominis plane block anesthesia in abdominoplasties. Plast Reconstr Surg 2011;128:529–535.
13. Wikner M. Unexpected motor weakness following quadratus lumborum block for gynaecological laparoscopy. Anaesthesia 2017;72:230–232.
14. Gautam B, Baral B. Spinal anesthesia for laparoscopic cholecystectomy in Parkinson’s disease. JNMA J Nepal Med Assoc 2018;56:701–704.
15. Thornblade LW, Seo YD, Kwan T, et al. Enhanced recovery via peripheral nerve block for open hepatectomy. J Gastrointest Surg 2018;22:981–988.
Copyright (c) 2020 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.