Continuous ultrasound guided erector spinae plane block for the management of chronic pain

Abstract

Neuropathic pain is a common chronic pain condition, whichcan develop due to a variety of etiologies such as surgery, trauma,herpes zoster, diabetes, and cancer[1]. It is usually difficult tomanage, and patients often show an insufficient response toanalgesic medications or experience intolerable adverse effects.Therefore, analgesic management is difficult, and the quality of lifeof the patient is adversely affected. Post-thoracotomy painsyndrome (PTPS) can be encountered in 25–47% of patientsundergoing either a thoracotomy or a video-assisted thoracoscopicsurgery (VATS). Initial management usually comprises NSAIDs,opioids and neuropathic agents[2].A variety of interventional procedures have been described fortreatment of thoracic refractory pain, including intercostal nerveblocks, thoracic epidural analgesia (TEA), thoracic paravertebralblocks (TPVB) and spinal cord stimulation. However, they can betechnically challenging to perform and are associated with asignificant failure rate (up to 15% in TEA) [3]. The erector spinae plane (ESP) block is a novel paraspinal planeblock first described for thoracic analgesia when performed at theT5 level[4]It has also been recently shown to be effective inproviding extensive somatic and visceral abdominal analgesiawhen performed at the T7-9 level[5]. ESP block is a goodalternative to other invasive techniques because the blockade canbe easily performed and has a low complication rate. An effectiveanalgesia can be provided and maintained by using continuous ESPblock. To illustrate this potential, we aimed to share our successfulexperience on using continuous ESP block in a patient with chronicpain in left thoracic and left axillary regions due to the malignmesenchymal tumour and Ewing’s sarcoma, which was unrespon-sive to the opioid mediation.