Case Report: Erector Spinae Block in Perforated Viscus

Abstract

Background

Erector spinae plane block (ESPB) a new block described for post-operative analgesia. Since 2016 the block has become a common practice in many institutions globally. Evidence has shown that ESPB is superior to truncal and abdominal wall blocks for many thoracic and abdominal surgeries.

Case Presentation

A 29-year-old male, ASA (American Society of Anesthesiologists) IIE patient presented with acute appendicitis. Patient was scheduled to undergo Laparoscopic Appendicectomy under general anesthesia (GA) with ESPB for post op analgesia. In the operating room after induction of GA patient received an ultrasound (US) guided bilateral ESPB at T10 level of the spinal cord with 20 mls of 0.25% levobupivacaine on each side. Intraoperatively the appendix was found to be normal and there was an incidental finding of perforated superior/first part of duodenum (D1). The duodenum was repaired. Patient remained hemodynamically stable intraoperatively. No intraoperative morphine was required. After uneventful extubation, the patient was transferred to post-operative anesthesia care unit (PACU). Patient reported pain score of zero on a 11-point numerical rating scale (NRS) in PACU. No morphine was required in the next 24 hours on the ward either.

Conclusion

ESPB can provide opioid free analgesia for laparoscopic repair of perforated duodenal ulcer both intra and postoperatively.

Keywords:

• erector spinae plane block
• perforated duodenal ulcer
• regional anesthesia
• truncal block
• levobupivacaine
• ESPB

Ethics Approval

This case report went through screening first by the Corporate Research Committee of the Dept. of Anesthesia.ICU and Perioperative Medicine, Hamad Medical Corporation (HMC). There by the case report was submitted to the Medical Research Centre of HMC through and was approved with ID MRC-04-21-871.

Patient Consent

A written informed consent was obtained from the patient to publish this case report.

Acknowledgment

The authors would like to thank and acknowledge Qatar National Library for providing funds for the publication of this case report.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No funding was required for this case report.