Epidural-Like Effect of a Continuous Right-Sided Erector Spinae Plane Blockade for Complicated Pediatric Abdominal Surgery

• Type of Material: Article
• Authors: Neil Doshi, Piedmont Athens Regional Medical Center; Vipin Bansal, Emory University; Emmanuel Alalade, Emory University
• Language: English
• Date: 2023-11-23
• Publisher: Elmer Press
• Publication Version: Final Published Version
• Copyright Statement: 2023, Doshi et al.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.14740/jmc4161
• Title of Journal or Parent Work: Journal of Medical Cases
• Volume: 14
• Issue: 11
• Start Page: 351
• End Page: 355
• Grant/Funding Information: None to declare.
• Keywords: Regional anesthesiology; Erector spinae plane block; Pediatric abdominal surgery; Epidural
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.