Erector Spinae Plane Block for Surgery of the Posterior Thoracic Wall in a Pediatric Patient

Objective Historically, regional anesthesia for surgery on the posterior thoracic wall has been limited to neuraxial and paravertebral nerve blocks. The erector spinae plane (ESP) block is a novel technique that anesthetizes the dorsal rami of the spinal nerves innervating the posterior thoracic wall. We report the use of the ESP block for this clinical application in a pediatric patient. Case Report A healthy 3-year-old girl was scheduled for resection of a giant paraspinal lipoma extending over the T4–T7 dermatomes. She received a preoperative single-shot ESP block at the level of the T1 transverse process; this level was chosen to avoid the lipoma and cover the planned surgical incision over the T2–T8 dermatomes. Hemodynamic stability and excellent pain control perioperatively were obtained with minimal anesthetic requirements and no systemic analgesics apart from fentanyl administered for induction of anesthesia. Return to normal function (ambulation, feeding, and communication) was achieved within 2 hours after surgery. A pain score of 0 on the FLACC (Face, Legs, Activity, Cry, Consolability) scale was maintained until discharge from the hospital 4 hours after the surgery. First analgesic use was 18 hours after hospital discharge. No complications were reported. Conclusions The ESP block is an effective option for surgery on the posterior thoracic wall. The opioid- and anesthetic-sparing effects exhibited in this case facilitated rapid postoperative recovery and early discharge. Accepted for publication July 30, 2017. Address correspondence to: Maria Alejandra Hernandez, MD, Department of Anesthesia, Pereira Rossell Pediatric Hospital, Bulevar Gral, Artigas 1550, 11600 Montevideo, Uruguay (e-mail: Hernandez.malaquina.alejandra@gmail.com). This work should be attributed to the Department of Anesthesia. Dr Orlando Alassia Children's Hospital, Santa Fe, Argentina. The authors declare no conflict of interest. Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.

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