Case

Patient

Operation

Erector spinae block

What we demonstrate

1

54 year old Chinese female

Left mastectomy with lateral intercostal perforator artery flap reconstruction

Indication:

Patient developed post operative moderate to severe pain despite having a pectoral nerve and serratus plane block, in addition to fentanyl, ketamine and oxycodone.

Block performed:

Post operative single shot unilateral ESP block at T4 level

A single shot ESP block can be an effective rescue analgesia block as shown by immediate and effective pain relief with widespread coverage from T1 to L1.

Access for injection was not an issue as we could perform it away from the anterior surgical site and dressings, and easily in a lateral position.

2

51 year old Chinese female

Right mastectomy, axillary sentinel lymph node biopsy and latissimus dorsi flap reconstruction with additional gel implant under flap

Left breast lump excision

Indication:

To provide intra and post operative analgesia.

Block performed:

Pre-induction unilateral sided ESP catheter performed at T3 level

An ESP catheter can be easily performed in an awake patient pre-induction.

The ESP catheter could also be placed remotely from the surgical site, with less risk of interference and infection of surgical site which was the concern with a paravertebral or pectoral nerve block respectively.

The ESP block provided extensive coverage from T4-L5.

3

36 year old Chinese female

Excision of right nipple

Removal of implant and pectoralis major fascia and left free transverse upper gracilis flap reconstruction

Indication:

To provide intra and post operative analgesia.

ESP Block performed:

Post-induction bilateral ESP with catheters at level T4 (right) and T12 (left)

We demonstrated widespread coverage of anaesthesia extending as far down as the thigh especially if placement was low enough (T12).

Like in case 2, with catheter(s) in-situ, it was versatile to titrate intermittent boluses of ropivacaine to prolong satisfactory analgesia.