Harlequin Syndrome Associated with Erector Spinae Plane Block

Sullivan, Timothy R.; Kanda, Pushpinder; Gagne, Sylvain; Costache, I.

doi:10.1097/aln.0000000000002733

Cited by 30 publications

(12 citation statements)

References 3 publications

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“…Ghamry et al supported our hypothesis stating better control of haemodynamic parameters with ESP; they found statistically significant lower mean heart rate and MABP with the intervention group than the control group [29].…”

Section: Case Nosupporting

confidence: 59%

“…Ghamry et al studied intraoperative fentanyl consumption in general anaesthesia based on ESP as an analgesic strategy, they found mean fentanyl consumption (75.5 ± 5.99 µg) in the intervention group compared to its analogue (298.2 ± 16.3 µg) in the control group. The difference was statistically significant (Pfentanyl < 0.001) and they concluded effective acute pain management of lumbar spine surgery with bilateral one-shot ESP [29].…”

Section: Case Nomentioning

confidence: 96%

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Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

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Section: Case Nosupporting

confidence: 59%

Section: Case Nomentioning

confidence: 96%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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“…Although this study reported no spread of dye to the ventral rami, several (published) studies have provided evidence, supporting the idea that anterior spread of local anesthetic provides visceral fiber blockade, explaining its use in thoracic, cardiac and abdominal surgery [9][10][11][12][13]. A recent case report described Harlequin syndrome after the ESP block, which is clearly consistent with the anterior spread of local anesthetic solution responsible for sympathetic fiber chain blockade [14].…”

Section: Discussionsupporting

confidence: 80%

Erector spinae plane block and altered hemostasis: is it a safe option? -a case series-

Galacho

Veiga

Ormonde

2020

Korean J Anesthesiol

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The erector spinae plane (ESP) block is a novel interfascial regional analgesic technique that was described by Forero et al. [1] in 2016, to treat thoracic neuropathic pain. Growing evidence of its efficacy and relative simplicity of performance has resulted in an increase in its use for managing acute and chronic pain [2-5]. The spread of local anesthetic through the paravertebral spaces is thought to be responsible for its analgesic effect on somatic and visceral pain, and thus, it has been reported to be as effective as thoracic epidural analgesia when administered bilaterally [6]. The ESP block may have some advantages over thoracic epidural analgesia, as it is a moderately simple technique that can be used unilaterally. It provides lesser sympathetic blockade with fewer cardiovascular effects, compared to the paravertebral block. However, the administration of the ESP block requires ultrasonographic guidance. The ESP block seems to be similar to a superficial block compared to the epidural and paravertebral blocks, with a lower risk of hemorrhage, especially in patients with altered hemostasis, i.e., the risk of spinal hematoma and spinal cord compression is lower, as the block is administered superficial to the transverse processes, allowing the spinal cord to be protected by the vertebral canal. However, these aspects have not been studied in depth and established firmly in current literature [7]. We describe a case series of 5 patients with altered hemostasis (activated partial thromboplastin time [aPTT] ratio or internatinal normalized ratio [INR] exceeding 1.5 times the normal value, a platelet count equal to or below 80000/μl, or use of anticoagulant Background: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis. Case: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/μl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days. Conclusions: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.

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“…40 Paravertebral spread of local anesthetic is likely after ESP block as evidenced by the following complications: Harlequin syndrome, a self-limited partial autonomic neuropathy after a T3 ESP block, and an unexpected bilateral sensory deficit after T9 ESP block have been reported and attributed to paravertebral spread. 41,42 Thus, patients should not be considered as candidates for high thoracic ESP if they would not tolerate a high thoracic epidural or paravertebral block. The American Society of Regional Anesthesia (ASRA) Guidelines recommend avoiding deep peripheral nerve blocks in anticoagulated patients.…”

Section: Discussionmentioning

confidence: 99%

<p>Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block</p>

Hernandez

Guvernator

Ansoanuur

et al. 2020

LRA

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Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.

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Harlequin Syndrome Associated with Erector Spinae Plane Block

Cited by 30 publications

References 3 publications

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Erector spinae plane block and altered hemostasis: is it a safe option? -a case series-

<p>Relief of Secondary Headaches with High Thoracic Erector Spinae Plane Block</p>

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