Ultrasound Guided Erector Spinae Plane Block for postoperative analgesia in abdominal surgeries: An Observational Pediatric Case Series
Pınar Kendigelen1, Aybike Onur Gönen1, Ayşe Çiğdem Tütüncü1, Rahşan Özcan2, Güner Kaya1
1Univeristy of Istanbul - Cerrahpasa, Department of Anesthesiology and Reanimation, Istanbul, Turkey
2Univeristy of Istanbul - Cerrahpasa, Department of Pediatric Surgery, Istanbul, Turkey
Erector spinae plane (ESP) block under ultrasound guidance is a recently described interfascial plane block targeting multi-dermatomal pain. Effectiveness of ESP block has been reported widely for neuropathic and post-operative thoracic, abdominal and pelvic pain in adult patients. Few case reports mention successful application in pediatric population. We report our experience of ESP block in a series of pediatric surgical patients. ESP block was performed on 15 patients, who were ASA physical status I or II between the ages 3 months and 7 years and had planned elective abdominal surgery under general anesthesia (Table). Written parental consent was attained for all patients. 12 patients received the block before the surgery and 3 patients after the surgery. ESP was reached between vertebral levels T8 and T12 (Figure 1) and 0.5 ml/kg of 0.25% bupivacaine solution was injected. 11 unilateral and 4 bilateral injections were performed depending on surgical incision. All patients had 1μg/kg fentanyl as a part of general anesthesia induction. We used the FLACC Pain Scale for pain assessment during the post-operative period and planned intravenous paracetamol for a score above 2 and tramadol for a score above 6. All patients had FLACC scores less than 2 and none received any analgesia in the first 6-hour post-op period. All FLACC score were below 6 in first 24-hour, therefore no one needed tramadol (Figure 2). None of the patients elicit any signs of systemic local anesthetic toxicity. Ultrasound guided ESP block is a promising analgesia method that seems a safe and effective choice in multi-modal analgesia offered to pediatric surgical patients. Prospective randomized studies are needed to compare efficacy and safety to abdominal field, epidural and paravertebral blocks, determine the ideal vertebral level of ESP block for different operations and establish optimal doses and volumes of local anesthetics.
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