Ultrasound-guided Lumbar Erector Spinae Plane Block For Postoperative Analgesia in Femur Fracture: A Pediatric Case Report

Abstract

The erector spinae plane (ESP) block is a recently defined regional anesthesia technique which is considered as an effective method in postoperative multimodal analgesia. ESP block is usually performed at the thoracic region in pediatric patients, but it is also possible to perform ESP block at the lumbar region. Femur fracture is one of the most common procedures especially in pediatric orthopedic surgery where postoperative pain management is essential. We aim to present a case of effective postoperative analgesia provided by ultrasound-guided lumbar ESP block in a 6-year-old patient after femur fixation surgery.

A cadaveric study of the erector spinae plane block in a neonatal sample

“…This ‘happily accidental’ block has been compared with other neuraxial techniques such as the epidural and paravertebral block and may prove to be a safer alternative 4. Although the ESP block has been successful in the adult population, there are only 42 documented cases (as of December 2019) in neonates, infant, and children 5–14. Despite the increasing number of indications for the ESP block, the anatomy, mechanism of action, concentration, and volume of anesthetic is yet to be determined especially in neonates and children 3 5…”

The anatomical features of an ultrasound‐guided erector spinae fascial plane block in a cadaveric neonatal sample

“…The therapeutic effect is attributed to the craniocaudal spread of local anesthetic over multiple vertebral levels within the tissue plane deep to the erector spinae muscle. It is also hypothesized that the interfascial spread blocks the ventral and dorsal rami of the spinal nerves providing visceral and somatic analgesia in the targeted area 3‐6 . To our knowledge, this is the only cadaveric study reporting on the spread and dermatomal coverage in a neonatal sample.…”

“…and dorsal rami of the spinal nerves providing visceral and somatic analgesia in the targeted area. [3][4][5][6] To our knowledge, this is the only cadaveric study reporting on the spread and dermatomal coverage in a neonatal sample.…”

The Effect of Ultrasound-Guided Erector Spinae Plane Block versus Thoracic Epidural Block on Postoperative Analgesia After Nuss Surgery in Paediatric Patients: Study Protocol of a Randomized Non-Inferiority Design Trial

“…21 However, published evidence for the efficacy of ESPB in paediatric patients is relatively insufficient. Apart from case reports and small series, [22][23][24][25][26] the literature regarding paediatric use is currently limited. Although one randomized trial reported that in paediatric patients undergoing splenectomy, ESPB reduced postoperative pain scores compared with those of sham controls, 27 there is a gap of evidence in directly comparing the analgesic efficacy between ESPB and the gold standard TEA in Nuss surgery.…”