Key result
A unilateral continuous right-sided erector spinae plane block at 4 cc/h of 0.1% ropivacaine provided adequate bilateral dermatomal coverage and pain relief without additional narcotics in a pediatric patient.
Why the study?
The erector spinae plane block provides an alternative to neuraxial anesthesia in patients with contraindications, and recent studies show multi-level spread impacting neural structures.
Does a high-volume unilateral continuous erector spinae plane block provide adequate bilateral analgesia in pediatric patients undergoing abdominal surgery?
Case Report (n=1)
No
Does a high-volume unilateral continuous erector spinae plane block provide adequate bilateral analgesia in pediatric patients undergoing abdominal surgery?
A unilateral continuous erector spinae plane block at a higher infusion rate may provide adequate bilateral analgesia for pediatric abdominal surgery when bilateral catheters are not feasible.
Hypothesis-generating for unilateral continuous ESPB in pediatric bilateral analgesia; prospective trials needed before clinical adoption.
The erector spinae plane block (ESPB) is increasingly gaining popularity in pediatric anesthesiology as it provides an alternative to neuraxial anesthesia in those with relative and absolute contraindications. Recent studies show craniocaudal spread in cadavers and multi-level spread impacting neural structures in live subjects. We present a case report of a pediatric patient with a history of abdominal surgeries, contraindication to neuraxial anesthesia, and thoracic vertebrae fractures. Bilateral ESPB catheters were initially placed but the left catheter was accidentally dislodged. Each ESPB catheter was initially programmed to flow at rate of 2 cc/h of ropivacaine 0.1% for a max combined rate of 4 cc/h. Once the left ESPB catheter was dislodged, the right ESPB catheter was programmed to flow at 4 cc/h which surprisingly continued to provide adequate bilateral analgesia for the patient without the need for additional narcotics. In cases where a unilateral ESPB catheter is the only option due to catheter displacement or contamination, administering a higher volume of local anesthetic may still yield satisfactory pain relief for managing postoperative discomfort following abdominal surgery.
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Bansal et al. (2023) conducted a case report in Postoperative pain following abdominal surgery (n=1). Continuous right-sided erector spinae plane block (ESPB) was evaluated on Postoperative pain control and dermatomal coverage. A unilateral continuous right-sided erector spinae plane block at 4 cc/h of 0.1% ropivacaine provided adequate bilateral dermatomal coverage and pain relief without additional narcotics in a pediatric patient.
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