Abstract
Uncontrolled pain after breast surgery can have early to chronic repercussions. The repertoire of pre-emptive opioid-sparing analgesic options includes regional blocks such as paravertebral blocks to myofascial blocks and more recently the Erector Spinae (ESP) block. Case 1 demonstrates the ESP block as an easy and conveniently performed post-operative rescue block for a patient who still experienced uncontrolled pain despite a combination of myofascial blocks and systemic analgesics. Case 2 and 3 demonstrate the advantage of providing an extensive coverage of surgical field in breast reconstruction surgery covering variable donor sites. It was due to the extent of coverage, that allowed the placement of ESP block catheter distantly without interrupting the surgical site. Post operative prolongation of pain relief was also successful by titrating analgesia via intermittent boluses. In our case series, the ESP block consistently and safely provided satisfactory pain relief for breast reconstruction surgery. It can be a viable option for peri-operative analgesia compared to other more invasive or less extensive alternatives.
Highlights
We describe our use of the erector spinae plane block in three patients who underwent elective breast reconstructive surgeries involving different types of flaps: the lateral intercostal perforator artery flap, latissimus dorsi and free transverse upper gracilis
Case 1 We present a 54-year-old lady (157 cm, 56 kg) who underwent a left mastectomy with lateral intercostal perforator artery flap reconstruction in the same setting
Our case series demonstrates the following advantages in using an Erector Spinae (ESP) block as part of a multimodal analgesic strategy for breast reconstruction surgery: The ESP block is easy to perform with a well-defined sonographic end-point – an injection between the bony transverse process and erector spinae muscle
Summary
It has been estimated that the incidence of chronic post-operative pain ranges from 25 to 60 percent among female population undergoing breast surgery with post-operative pain scores as a main predictor [1]. Multimodal analgesics with regional anaesthesia techniques with pectoral nerve block, serratus plane block and paravertebral blocks have traditionally been used for breast surgery. An erector spinae plane block first reported in 2016 [2], has been shown to block the dorsal rami (anesthesia) and provide analgesia to the ventral rami of the thoracic and lumbar region [3]. We describe our use of the erector spinae plane block in three patients who underwent elective breast reconstructive surgeries involving different types of flaps: the lateral intercostal perforator artery flap, latissimus dorsi and free transverse upper gracilis
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