Erector Spinae Plane Block– An Analgesic Technique for Laparoscopic Liver Resection: A Case Series

Abstract

Introduction: Postoperative pain after liver surgery can be significant and yet difficult to manage. Epidural analgesia is widely used for pain relief after liver surgery. However there has been a progressive reduction in the use of epidural analgesia within an enhanced recovery program. The erector spinae plane block is a recently described regional anesthetic technique for providing abdominal analgesia when performed at the level of the T7 transverse process. Its mechanism of action is not yet clear, despite this providing somatic and visceral analgesia during surgery. Cases presentation: We report five patients undergoing laparoscopic liver resection in which the somatic and visceral intraoperative pain were covered by the right erector spinae plane block. In addition, a transversus abdominis plane plus oblique subcostal transversus abdominis plane blocks were performed on the left hemisome to cover the somatic pain due to skin incision and laparoscopic ports insertion. For postoperative pain relief, a catheter was inserted during the execution of the erector spinae plane block and a levobupivacaine infusion was maintained for 36 hr through it. Conclusions: A continuous right erector spinae plane block could be an effective analgesic technique in patients undergoing laparoscopic liver resection. However, further prospective studies with large number of patients are needed to evaluate the effectiveness of this block in liver surgery. Keywords: ESP block ; Erector spinae plane block ; Regional anesthesia ; Hepatic surgery ; Pain management.