Ultrasound Guided Erector Spinae Block with Costotransverse Ligament Puncture Is More Effective than Erector Spinae Block Alone; Eight Cases for Oncologic Breast Surgery; A Brief Technical Report

Abstract

Objectives: Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESP) is a newly defined promising technique for this purpose. Since the description by Forero, ultrasound-guided erector spinae block (ESP) has performed for several surgeries for postoperative analgesia. Many regional methods pectoral nerve block (PECs), serratus plane block (SPB), were described in the literature for maintaining postoperative analgesia. Among all these regional anesthesia techniques, paravertebral block (PVB) is the most studied and found to be a valid regional technique for this purpose. Due to its anatomic proximity to the pleura and central neuraxial system, it's also one of the most challenging techniques. Materials and Methods: Patients aged between 37 and 47 years, American Society of Anesthesiologists physical status I-II and scheduled for elective unilateral modified radical mastectomy (MRM) surgery without axillary lymph node dissection were enrolled to this case series. In this report, we describe a novel combination of ESP and simplified PVB block and its successful application in 8 cases of oncologic breast surgery. In our clinic, ESP block is performed for all oncological breast cases. Eight cases of MRM without axillary dissection were randomly selected by the same anesthesiologist (AŞ). 15 mL 0.25% bupivacaine was administered between the erector spinae muscles and the transverse process at the level of the 4th thoracal vertebra with the caudo-cranial approach.

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

“…Only intertransverse and superior costotransverse ligaments are found in the thoracic region posing a possible obstacle [ 19 ]. Some authors reported benefits of technical refinements of ESPB such as double injection technique, multiple level injections and injecting near the costotransverse ligament in breast procedures, to improve LA diffusion into the paravertebral space [ 20 – 22 ]. There are no published trials on these new approaches for performing ESPB in abdominal surgery.…”

Evaluation of Analgesic Effectiveness of Continuous Erector Spina Plane Block in Patients Undergoing Thoracotomy

“…Combination of desflurane with air -oxygen (2:1) mixture in 2 L of fresh gas flow was used for anesthesia maintenance. At the end of the surgery paracetamol 1 g and tramadol 100 mg iv were administered for providing postoperative analgesia and also ondansetron 8 mg was given for the prevention of postoperative nausea and vomiting [11] .…”