After speaking to a colleague of mine regarding regional anesthesia for thoracotomy and mastectomy, I am reading up on Erector Spinae Plane (ESP) block.
- Rib fractures
- Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: A Case Report. A & A Case Reports. 8(10):254–256, MAY 2017.
- The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Regional Anesthesia and Pain Medicine. Volume 41, Number 5, September-October 2016.
- The Ultrasound-Guided Continuous Erector Spinae Plane Block for Postoperative Analgesia in Video-Assisted Thoracoscopic Lobectomy. Regional Anesthesia and Pain Medicine: July/August 2017 – Volume 42 – Issue 4 – p 537.
Erector spinae plane block as an alternative to epidural analgesia for post-operative analgesia following video-assisted thoracoscopic surgery: A case study and a literature review on the spread of local anaesthetic in the erector spinae plane. Indian J Anaesth. 2018 Jan; 62(1): 75–78.
- Mastectomy/Breast reconstruction
- Abdominal surgery
- Continuous Erector Spinae Plane (ESP) Analgesia In Different Open Abdominal Surgical Procedures: A Case Series. Journal of Anesthesia and Surgery. https://doi.org/10.15436/2377-1364.18.1853.
Bilateral Continuous Erector Spinae Plane Block Contributes to Effective Postoperative Analgesia After Major Open Abdominal Surgery: A Case Report. A&A Practice: December 1, 2017 – Volume 9 – Issue 11 – p 319–321
Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study. Anesthesia & Analgesia: July 2019 – Volume 129 – Issue 1 – p 235-240
- Cardiac surgery
- Continuous Erector Spinae Plane (ESP) Block for Postoperative Analgesia after Minimally Invasive Mitral Valve Surgery. October 2018Volume 32, Issue 5, Pages 2271–2274.
- Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth 2018;21:323-7.
Continuous ESP block catheter (my current regimen and what I’m able to get at my institution):
- Braun Periflex catheter through 17g epidural needle
- Cranial-to-caudal approach @ T5 (mastectomy, vats, rib fractures)
- 20ml 0.25% bupi + epi prior to catheter
- Catheter 5cm in space
- 5 ml 0.25% bupi + epi after catheter placed
- Mix: 0.125% bupi + fentanyl @ 10 ml/hr
- If PCEA available, bolus 15ml every 3 hours; continuous as mix above.