Erector spinae plane block for multimodal analgesia after wide midline laparotomy A case report

Rationale: The most commonly used regional techniques for analgesia following laparotomy thoracic epidural analgesia and paravertebral blocks are technically difficult to perform and carry a risk of severe complications. Recently, the erector spinae plane block (ESPB) has been reported to effectively treat neuropathic pain. The ultrasound-guided ESPB is an easily performed fascial plane block that can provide sensory blockade from T2-4 to T12-L1. Moreover, the ESPB reportedly blocks both the ventral rami of spinal nerves and the rami communicants, which contain sympathetic nerve fibres, through spread into the thoracic paravertebral space. Patient concerns: We report the case of a 35-year-old female patient who underwent excision of a larger ovarian mass via laparotomy with a wide, midline incision from the xiphoid process to the pubic tubercle. Diagnoses: They were diagnosed with mucinous cystadenoma originated from the right ovary and fallopian tube, and a right oophorectomy and salpingectomy were performed. Interventions: The ESPB was performed for postoperative pain control at the level of the T8 transverse process. Postoperative multimodal analgesia was provided according to the acute pain service protocol of our hospital. The patient was prescribed oral acetaminophen 175mg every 6hours and intravenous patient-controlled analgesia (PCA) with fentanyl 7 mu g/mL. A 1: 1 mixture of 0.75% ropivacaine (20mL) and saline (20mL) with epinephrine (1: 200,000) was manually injected through the indwelling catheter every 8hours (20mL per side). Outcomes: The first demand dose of fentanyl was administered at 9hours and 39minutes after the surgery. There were no reported resting pain scores >4, nor were any rescue analgesics needed during the first 5 postoperative days. Lessons: The ESPB provided highly effective analgesia as a part of multimodal analgesia after laparotomy with a wide midline incision.