Bilateral Lumbar Erector Spinae Plane Block for Pain Control in Open Ureteric Repair and Reimplant: A Case Report

Abstract

Introduction: Lower abdominal surgery often leads to severe postoperative pain and challenge for anesthetists regarding its management. A multimodal approach with regional anesthesia techniques might be an opportunity. Erector spinae plane block (ESPB) is usually used for pain management in thoracic and abdominal surgery. New surgical indications are increasingly suggested for lumbar ESPB (spine and urological surgery) both in pediatric and adult procedures. In this case report, we present the results of the fascial block at the lumbar spine in an adult patient for lower abdominal surgery. The purpose of this procedure is to offer the patient an alternative to neuraxial anesthesia/analgesia and opioid-sparing anesthesia. Case Presentation: Bilateral lumbar ESPB in a 46-year-old female patient scheduled for bilateral open ureteral reimplantation surgery after iatrogenic injury was performed at the Civil Hospital of Teramo in Italy (January 2022). Postoperative pain evaluation reported a substantial absence of pain. The patient was promptly mobilized, and the postoperative course was free of complications. There was no additional opioid administration. Conclusions: To the best of our knowledge, this has been the first described lumbar ESPB case for intraoperative and postoperative analgesia in adult bilateral ureters replacement and reimplantation after iatrogenic injury. We suggest bilateral lumbar ESPB, as already reported for numerous lower abdominal surgeries, as a valid alternative in perioperative pain management in adults’ ureteral reimplant.