Users Online: 449 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to [email protected] preferably by 30th June 2019.

 

 
Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 126-127

Ultrasound guided erector spinae plane block –An effective rescue analgesia for pediatric open upper abdominal surgery


Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

Date of Submission13-Feb-2020
Date of Acceptance28-Apr-2020
Date of Web Publication10-Apr-2021

Correspondence Address:
Dr. Aswini Kuberan
Department of Anesthesiology and Critical care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_69_20

Rights and Permissions

How to cite this article:
Kuberan A, Swaminathan N, Sethuramachandran A, Balasubramanian M. Ultrasound guided erector spinae plane block –An effective rescue analgesia for pediatric open upper abdominal surgery. J Anaesthesiol Clin Pharmacol 2021;37:126-7

How to cite this URL:
Kuberan A, Swaminathan N, Sethuramachandran A, Balasubramanian M. Ultrasound guided erector spinae plane block –An effective rescue analgesia for pediatric open upper abdominal surgery. J Anaesthesiol Clin Pharmacol [serial online] 2021 [cited 2021 Jun 25];37:126-7. Available from: https://www.joacp.org/text.asp?2021/37/1/126/313426

Dear Editor,

The erector spinae plane block (ESPB), since its initial description in 2016,[1] has also been described as a modality for intraoperative and postoperative analgesia in thoracoscopic, laparoscopic, and open thorocoabdominal surgeries in pediatric patients.[2] We would like to report the use of ESPB as a rescue analgesic, in a 4-year-old male child weighing 15 kg, who underwent right sided adrenalectomy for a functioning adreno-cortical tumor. Written informed consent was obtained from the parent for the purpose of publication.

The surgical plan was robotic-assisted laparoscopic adrenalectomy. Our analgesic plan included intravenous fentanyl, paracetamol, and ketorolac. After 5 h of surgery, surgeons planned to open the abdomen due to difficult dissection and bleeding, with a subcostal incision extending from T7 to T10 on the right side. Intraoperative surgical response was managed with IV fentanyl (total dose of 45 mcg). A single-shot right sided ESPB was performed for postoperative analgesia at the end of surgery. In the same left lateral position, after aseptic precautions, a high frequency linear transducer probe (6 to 15 MHz SonoSite S series; Bothell, WA, USA) was placed in longitudinal para-sagittal direction 2 cm lateral and parallel to the T7 to T10 spinous process marked [Figure 1]a. The probe was moved laterally to visualize the tip of transverse process T9 [Figure 1]b. A 5 cm 20 G needle was inserted in-plane, caudal-cranial direction, to reach below erector spinae muscle (ESM). After negative aspiration, 1 ml of normal saline was injected to confirm the spread of saline. Once cranio-caudad spread was confirmed, 10 ml of 0.25% bupivacaine (0.5 ml/kg) was deposited below the ESM sheath [Figure 1]c. Following the block, infiltration with local anesthetic (4 ml of 0.25% bupivacaine) was done at the laparoscopic port sites before extubation. Later the child was extubated and shifted to pediatric intensive care unit (PICU). In PICU, child had stable vital signs with no tachycardia, respiratory rate 15/min, alert and comfortable with FLACC (Face, Legs, Activity, Cry, Consolability) scale of 0. No rescue analgesic (IV fentanyl) was used for 24 h postoperatively. Paracetamol (IV) 10 mg/kg was administered every 6 h for 48 h. No side effects of the block were reported.
Figure 1: (a) Patient in left lateral position, probe oriented in sagittal direction over the marked spinous process from T7 to T10. In-plane insertion of needle from caudad direction. (b) Para-sagittal ultrasonographic visualization of flat hyperechoic transverse process from T7 to T10.(c) Needle tip above the T9 transverse process. Local anesthetic drug lifting up ESM with cranio-cephalad spread from T7 to T10

Click here to view


In the ESPB, the drug is deposited deep to the ESM sheath and superficial to transverse process, as close as possible to the origin of the dorsal rami of the spinal nerves in the targeted dermatomes and a cephalocaudal distribution of drug is expected.[1] We chose ESPB as a rescue analgesic technique rather than caudal anesthesia to avoid bilateral sensory block, urinary retention, and early ambulation.[3] Lower thoracic epidural can be a better alternative, but it has been reported with unrecognized dural taps, multiple attempts, total spinal anesthesia, and nerve injuries in pediatric population.[4] Our experience with this patient emphasizes the utility of the ESPB as a rescue analgesic modality during unplanned conversion from minimally invasive surgical approach to an open surgical approach.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A novel analgesic technique in thoracic neuropathic pain. RegAnesth Pain Med 2016;41:621-7.  Back to cited text no. 1
    
2.
Holland EL, Bosenberg AT. Early experience with erector spinae plane blocks in children. PediatrAnesth2020;30:96-107.  Back to cited text no. 2
    
3.
Wiegele M, Marhofer P, Lönnqvist P-A. Caudal epidural blocks in paediatric patients: A review and practical considerations. Br J Anaesth2019;122:509-17.  Back to cited text no. 3
    
4.
Ecoffey C, Lacroix F, Giaufré E, Orliaguet G, Courrèges P. Epidemiology and morbidity of regional anesthesia in children: A follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF). PediatrAnesth2010;20:1061-9.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed208    
    Printed0    
    Emailed0    
    PDF Downloaded48    
    Comments [Add]    

Recommend this journal