Erector spinae plane block for postoperative analgesia in thoracoscopic lobectomy in a paediatric patient

Dear Editor,
Opioid-free management of pain in paediatric patients is considered a challenge for anaesthesiologists [1]. In recent years, ultrasound-guided peripheral blocks have gained popularity due to their safety and efficacy in providing pain relief and rapid recovery. Recently, the erector spinae plane (ESP) block has been used for postoperative analgesia for open heart surgery, oncological thoracic surgery, and abdominal laparoscopic procedures in paediatric populations [2–5]. Herein we report a case of a single-shot ESP block for postoperative analgesia in a paediatric patient undergoing thoracoscopic lobectomy.
A 13-month-old male patient with an intralobar sequestration in the right lung was scheduled for lobectomy via video-assisted thoracoscopy. Balanced anaesthesia was given as follows: after pre-oxygenation with 100% O2 for 3 min, anaesthesia was induced with injection of propofol 6 mg i.v. plus fentanyl 20 µg, cisatracurium 1.4 mg, and maintenance with balanced anaesthesia with sevoflurane 1 minimum alveolar concentration and remifentanil 1.5 µg min-1 for intraoperative analgesia. There were no intraoperative complications. Following completion of the surgery, which lasted 2.5 hours, and with parental consent, the patient was placed in the lateral decubitus position and given standard analgesia of 1.5 γ dipyrone and 0.1 mg hydromorphone as well as an ultrasound-guided single-shot ESP block using a 22 G, 60-mm needle that was directed toward the tip of the T4 transverse process (Figure 1A). This was also followed by an injection of 5 mL of bupivacaine 0.25% (Figure 1B) by visualising the craniocaudal spread of the local anaesthetic and dissection of the fascia (Figure 1C). Haemodynamic parameters were stable and emergence from anaesthesia was uneventful.
Assessment of pain was done by using the Wong-Baker FACES scale [6]. Rescue analgesic was given if FACES scale score was ≥ 3 with methimazole plus paracetamol. During the postoperative period, only multimodal analgesia with methimazole plus paracetamol was given at 1, 24, and 48 hours postoperatively without the need of any rescue with opioids. FACES score at the time of rescue analgesic was 3.1 ± 0.4 and FACES score at 24 hours was 0.6 ± 1.1. The patient was discharged three days after surgery without any evidence of perioperative pain. We did not see evidence of any side effects such as postoperative sedation, nausea and vomiting, pruritus, or...


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