Erector spinae catheter for post-thoracotomy pain control in a premature neonate.
Anna Swenson SchalkwykJames FlahertyDonavon HessBalazs HorvathPublished in: BMJ case reports (2020)
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.
Keyphrases
- pain management
- low birth weight
- chronic pain
- ultrasound guided
- preterm infants
- spinal cord
- aortic valve replacement
- preterm birth
- cardiac surgery
- patients undergoing
- minimally invasive
- low dose
- case report
- heart failure
- spinal cord injury
- mechanical ventilation
- aortic valve
- thoracic surgery
- respiratory failure
- acute coronary syndrome
- left ventricular
- transcatheter aortic valve replacement
- extracorporeal membrane oxygenation