Erector spinae plane block for affective and safe analgesia in a patient with severe penetrating chest trauma caused by an explosion in the battlefield

Abstract

The ongoing conflict in Ukraine continues to generate many complex traumatic injuries and provides unique challenges to anaesthesiologists who provide medical care at various levels of medical evacuation. We report the successful use of an ultrasound-guided continuous erector spinae plane (ESP) block in a patient with severe posterolateral chest trauma. The acute perioperative outcome of the patient was improved with the ESP block, the main benefits being excellent analgesia and minimal postoperative morphine requirements without influencing the risk of bleeding and coagulopathy. We conclude that continuous ESP block can be utilized to provide excellent analgesia following massive thoracic trauma.It's ease of placement under ultrasound guidance and low risk of complications makes this technique particularly useful in war medicine. K E Y W O R D Scombat anesthesia, continuous peripheral nerve block, erector spinae plane block (ESP), postoperative regional anesthesia How to cite this article: Dmytriiev D, Dîrzu DS, Melnychenko M, Eichholz R. Erector spinae plane block for affective and safe analgesia in a patient with severe penetrating chest trauma caused by an explosion in the battlefield.

Regional anesthesia and POCUS in the intensive care unit

“…In a recent case report, a patient who suffered penetrating trauma in the ongoing conflict in Ukraine received an ESP block, which resulted in excellent analgesia and minimal postoperative opioid requirements. 48 At our institution, the acute pain service routinely consults with the ICU regarding recent admissions for penetrating trauma, and we evaluate patients for potential RA. Recent advances in fascial plane blocks enable RA in such patients who often have coagulopathies and who may be difficult to position for TEA or PVB.…”

“…Postoperatively, many patients are in the ICU, may be hemodynamically unstable, and pain management is often overlooked. In a recent case report, a patient who suffered penetrating trauma in the ongoing conflict in Ukraine received an ESP block, which resulted in excellent analgesia and minimal postoperative opioid requirements 48 . At our institution, the acute pain service routinely consults with the ICU regarding recent admissions for penetrating trauma, and we evaluate patients for potential RA.…”