Abstract
Single injection, ultrasound-guided nerve blocks have drastically changed the multimodal approach to pain management of the acutely injured patient in the emergency department (ED). Ultrasound-guided femoral nerve blocks in the ED have become standard aspects of multiple, hospital system pain management protocols, with early evidence demonstrating improved patient outcomes. Developing a multimodal pain management strategy can improve analgesia while reducing reliance on opioids in this era of opioid addiction.1 The single injection, ultrasound-guided erector spinae plane (ESP) block is a technique safely used for pain control for rib fractures that can be easily performed at the bedside and integrated into optimal emergency care. A more inferiorly located ultrasound-guided ESP block has been recently described in the anesthesia literature for perioperative pain control for various abdominal surgeries but has not yet been described for patients with acute appendicitis. Here we describe a single injection, lower ESP block performed by emergency physicians that successfully alleviated pain from acute appendicitis in an ED patient awaiting definitive surgical treatment. Along with allowing clinicians to actively manage pain without reliance on opioids, this novel ED technique may improve patient care outcomes.
Highlights
Acute appendicitis is commonly diagnosed in the emergency department (ED), where intravenous (IV) opioids are the primary analgesic used to control pain while patients await definitive surgical care.[2]
Several reports suggest benefit of the erector spinae plane (ESP) block for the pain associated with major open abdominal surgery, bariatric surgery, ventral hernia repair, abdominal zoster, laparoscopic cholecystectomy, inguinal hernia repair, and cesarean section.[6,7,8,9,10,11]
Previous case reports in the anesthesiology literature indicate that ESP block placed at the T8-T9 level may be preferred as it is less likely to cause excessive lower lumbar blockade, and it is easier to target since the transverse process is located more superficially at that level.[7,8,9,11,12]
Summary
Acute appendicitis is commonly diagnosed in the emergency department (ED), where intravenous (IV) opioids are the primary analgesic used to control pain while patients await definitive surgical care.[2] Increasingly, data support the benefits of opioid-sparing multimodal analgesia for intraabdominal surgery as part of enhanced recovery after surgery protocols.[3] little has been studied in the preoperative period, while patients are in the ED. The ultrasound-guided erector spinae plane (ESP) block, developed for both chronic and surgical thoracic pain and later adopted by EPs for management of acute rib fractures, is thought to provide relief for both somatic and visceral pain.[4,5,6]. We present the first description of a successful, ultrasound-guided ESP block for pain control in preoperative acute appendicitis
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