Continuous Erector Spinae Plane Block for Postoperative Analgesia After Intestinal Resection and Hernia Repair Surgery: A Case Report.

Abstract

BACKGROUND Erector spinae plane block is a reliable and efficient analgesic method that can be used when alternatives are ineffective or impractical, and is a possible alternative to epidural anesthesia. This case report details the effective implementation of a continuous bilateral erector spinae plane block in a post-laparotomy patient, addressing the clinical complexities associated with the patient's polymorbidity and, notably, the main challenge of reinitiating anticoagulants postoperatively. CASE REPORT A 64-year-old man was scheduled for a major anterior abdominal wall hernioplasty. The surgery revealed severe complications from the previous hernioplasty, necessitating intestinal resection, and because of the ischemic changes in the sigmoid colon, a sigmoid resection with the creation of anastomoses was performed in addition to the scheduled hernioplasty. After the surgery, the patient was transferred to the Intensive Care Unit (ICU), with severe postoperative pain. Two catheters were placed bilaterally at the Th11 level for erector spinae plane blockade, and a 0.125% bupivacaine infusion was initiated at a rate of 5 ml/h. Despite the need for immediate application of anticoagulants due to the comorbidities of the patient, no complications associated with catheters occurred during the postoperative period. CONCLUSIONS The use of a prolonged ESP block with bilateral catheter insertion is a reliable and efficient approach for providing long-term pain relief in patients following extensive abdominal surgery.