Erector Spinae Plane Block for Effective Analgesia after Total Mastectomy with Sentinel or Axillary Lymph Node Dissection: a Report of Three Cases

1/3 https://jkms.orgThree patients underwent total mastectomy with sentinel/axillary lymph node dissection.After the surgical procedure, ultrasound (US)-guided erector spinae plane block (ESPB) was performed.The fifth rib and transverse process (TP) was located using a 5-12 MHz linear probe; this was marked on the skin.At this level, the probe was moved from the lateral to the medial side transversely to identify any change in shape that traversed the rib and TP.Where the round shadow of the rib shifted to the rectangular shape of the TP, an 18-G Tuohy needle was inserted by using the in-plane technique (Fig. 1).After penetrating the erector spinae muscle, the needle was located in the fascial plane between the TP and erector spinae muscle.We confirmed that the fascial plane was well-separated by injecting 2 mL of saline.Then, 0.375% ropivacaine 30 mL with epinephrine (1:200,000) was injected, and the catheter was inserted 2 cm over the tip of the needle under real-time US guidance (Figs. 2 and 3).After the ESPB procedure, fentanyl 50 µg and ketorolac 30 mg were administered intravenously, and the patients were allowed to