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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 5  |  Issue : 2  |  Page : 185-186

Unilateral ultrasound guided - Erector spinae plane block as an independent technique for right anterolateral chest wall lipoma


1 Associate professor, Dept. of Anesthesiology, IGIMS, Patna, Bihar, India
2 Assistant professor, Dept. of Anesthesiology, IGIMS, Patna, Bihar, India
3 M.B.B.S, M.D. trainee, Dept. of Anesthesiology, IGIMS, Patna, Bihar, India

Date of Submission28-Mar-2019
Date of Acceptance18-Jul-2019
Date of Web Publication12-Aug-2019

Correspondence Address:
Swati Singh
Assistant professor, Dept. of Anesthesiology, IGIMS
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Ultrasound guided -Erector spinae plane block (US-ESP)has been reported till now along with general anesthesia for postoperative pain management. We report here using the same as an independent technique for excision of a tumour present on right anterolateral chest wall.

Keywords: lipoma, nerve block, breast surgery Key Messages : erector spinae plane block as an independent technique for anterolateral wall lipoma surgery.


How to cite this article:
Swati, Singh S, Shiromani S. Unilateral ultrasound guided - Erector spinae plane block as an independent technique for right anterolateral chest wall lipoma. J Indira Gandhi Inst Med Sci 2019;5:185-6

How to cite this URL:
Swati, Singh S, Shiromani S. Unilateral ultrasound guided - Erector spinae plane block as an independent technique for right anterolateral chest wall lipoma. J Indira Gandhi Inst Med Sci [serial online] 2019 [cited 2022 Aug 12];5:185-6. Available from: http://www.jigims.co.in/text.asp?2019/5/2/185/301110




  Introduction: Top


Ultrasound guided - Erector spinae plane (US-ESP) block , a newly described paraspinal block has been widely used for different thoracic and abdominal surgery for postoperative analgesia.[1] In this block, local anesthetic is deposited deep to erector spinae muscle at required level and gets evenly distributed a few segment above and below causing block of ventral and dorsal rami of multiple spinal nerves. [2] If this block is given bilaterally it produces result similar to epidural block but it is simpler and associated with less complications. In this case report we are describing use of US-guided erector spinae plane block as an independent technique for excision of a lipoma present on left upper anterolateral thoracic region.


  Case Report: Top


A 23-year-old man presented with swelling on the right side of upper chest since 2 year. [Figure 1]A it was insidious in onset, gradually progressive, and painless. There was no history of trauma, fever, or cough. On examination, a non tender, non reducible , non pulsatile mass measuring about 5 x 6 cm with no bruit was seen on right upper anterolateral thorax. On general physical examination , the patient weighs 58 kg, 162 cm in height, pulse rate of 68/ min and blood pressure of 130/70mm of Hg. The routine investigation was within normal limit.The clinical diagnosis of the tumour was made as lipoma hence simple excision was planned.


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It was planned to get it excised under right sided ultrasound guided-erector spinae (US- ESP) block followed by intravenous sedation . Patient was explained about the procedure and consent was taken. no sedation was given during the regional block procedure. A unilateral US -ESP block was performed at the level of the fifth thoracic vertebrae in sittng position. A high- frequency linear ultrasound probe (fuzifilm sonosite) was placed in a longitudinal orientation 3 cm lateral to left from midline, and 3 muscle of posterior thoracic wall (trapezius, rhomboideus major, and erector spinae) were identified superficial to hyperechoic transverse process shadow. After giving 3ml 2 % lignocaine for local subcutaneous infilteration a 18 -guage Tuohy needle was inserted from cephalad to caudad direction until tip lay in the interfascial plane deep to the erector spinae muscle.[Figure 1]B Hydrolocalization with normal saline was done and 20ml 0.5% bupivacaine was injected at T5 level, which had spread to block T2-T9 unilaterally (left) [Figure 1]C. The block was followed by mild sedation with intravenous inj. midazolam 1mg and propofol infusion at the rate of 40mcg/kg/min . Intraoperative vitals of the patient remained within normal limit - heart rate-70-90 bpm, systolic blood pressure - 120- 130, Diastolic blood pressure - 70-88 mm of Hg, saturation - 99-100 % and end tidal CO2 - 32 - 40 mm of Hg. The surgery lasted for 25 minutes. [Figure 1]D In Postoperative period pain was rated on 11 -point numerical rating scale (NRS) score after recovery from anaesthesia NRS score of patient was [3]. In PACU NRS scoring was done at every 2 hrs and if score was more than 4 , intravenous morphine 0.05 mg / kg BW was given for pain relief. There was no requirement of morphine till 6 hours postoperatively. the NRS score during the 6hours in post-operative period analyzed 2 hourly was 2/11-3/11-311. the analgesic given after 6hours in post-operative period was Inj. Tramadol 100 mg IV SOS


  Discussion : Top


General anaesthesia has been mostly used for thoracic surgery. US guided - ESP block till now has been described mostly for postoperative analgesia not as an primary anaesthesia technique.[1],[2],[3] For short day care based surgeries if the surgical procedure can be done under regional anesthesia, then unwanted complications of general anaethesia like nausea and vomiting, sedation etc can be avoided. Thoracic paravertebral block (TPVB) along with light sedation has been used for breast surgeries.[4] Since US guided - ESP block also targets ventral and dorsal rami of spinal nerves like TPVB we used this with sedation for excision of anterolateral thoracic tumour extending dermatome T6-T9. In this block, we deposited drug below erector spinae muscle opposite T 5 vertebrae, a very good analgesia was obtained covering dermatome T2 - T 9. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique.



 
  References Top

1.
Boughey JC, Goravanchi F, Parris RN et al. Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery. Am J Surg 2009; 198:720-5.  Back to cited text no. 1
    
2.
Scimia P, Basso Ricci E, Droghett A, Fusco P. The ultrasoundguided continuous erector spinae plane block for postoperative analgesia in videoassisted thoracoscopic lobectomy. Reg Anesth Pain Med 2017;42:537.  Back to cited text no. 2
    
3.
Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: A Novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016;41:621-7.  Back to cited text no. 3
    
4.
Klein SM, Bergh A ,Steele S M, Georgiade G S, Greengrass R A. Thoracic Paravertebral Block for Breast Surgery. Anesthesia & Analgesia 2000;90:1402-1405.  Back to cited text no. 4
    


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