Erector spinae catheter for post-thoracotomy pain control in a premature neonate. Issue 9 (7th September 2020)

• Record Type: Journal Article
• Authors: Swenson Schalkwyk, Anna; Flaherty, James; Hess, Donavon; Horvath, Balazs
• Is Part Of: BMJ case reports. Volume 13:Issue 9(2020)
• Publication Date: 2020-09-07
• Subjects: pain -- drug therapy related to surgery -- neonatal and paediatric intensive care -- paediatric surgery; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-234480
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Ensuring respiratory stability with early tracheal extubation and adequate pain control is challenging in premature neonates after thoracotomy. Continuous erector spinae plane (ESP) block, a relatively new truncal nerve block, has the potential to provide analgesia for thoracic surgeries while reducing opioid use. However, there have been only a few reports utilising this technique in infants, and none in preterm neonates. We present the perioperative pain management of a preterm neonate requiring thoracotomy. Epidural analgesia was deemed contraindicated due to coexisting coagulopathy; therefore, an ESP catheter was placed. The patient was extubated at the end of the surgery and had excellent pain control with rectal acetaminophen, chloroprocaine infusion via the ESP catheter and with minimal opioid requirement. Continuous ESP block may be safe and effective for postoperative pain management in coagulopathic premature neonates. Chloroprocaine is an effective local anaesthetic in the erector spinae compartment, which has not been previously reported.