Ultrasound-guided erector spinae plane nerve block for relief of acute cholecystitis pain

Abstract

Background: Acute cholecystitis is a common surgical emergency and a painful condition that often requires frequent intravenous opioid analgesia. Sometimes, pain control of patients with acute cholecystitis is challenging. In this case, we present a potential alternative to managing acute cholecystitis pain.Case Report: A 40-year-old female presented to the ED with right upper quadrant pain. While awaiting testing and ultrasound, she received multiple doses of opioid analgesia. A point-of-care ultrasound of the right upper quadrant was performed and demonstrated findings of acute cholecystitis. Given that her pain was challenging to manage, even with intravenous opioids, an ultrasound-guided erector spinae plane (ESP) nerve block was discussed and subsequently performed at the T7 level. Thirty minutes after the procedure, the patient reported significant relief of her pain and did not require any opioid analgesia until ten hours later on the inpatient floor.Why should an emergency medicine physician be aware of this?ESP nerve blocks can potentially offer an alternative analgesic in the management of acute cholecystitis, subsequently reducing the use of opioids in the ED.ESP nerve blocks can potentially offer patients longer-lasting analgesia.ESP nerve blocks can potentially manage visceral pain in the ED.