Carcinoid syndrome: Innovative anesthetic approach utilizing erector spinae plane block

Abstract

A 57-year-old female with history of carcinoid syndrome along with extensive liver metastases presented for a right sided mastectomy and implant insertion for breast cancer. Preoperative optimization included an octreotide infusion and anxiolysis, as well as planning a cardiostable anaesthetic that avoided any crisis stressors. Ultrasound guided thoracic (T4) ESP block using 0.2% Ropivacaine was given under propofol sedation followed by remifentanil and propofol anaesthesia. Octreotide infusion along with boluses was used to treat hypotension and bradycardia intraoperatively. The combination of perioperative octreotide administration, intraoperative remifentanil and propofol anaesthesia and ESP block provided satisfactory anaesthesia. The block was effective for 36 hours post-operatively and the patient was discharged 48 hours post admission. We suggest that a novel interfascial plane block, ESP block is a useful addition to the armamentarium of the anaesthetist in the management of a patient with carcinoid syndrome with an aim to decrease dependence on morphine and preventing conversion to chronic pain.