The 68th
Scientific Meeting
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| 19S-023 |
Ultrasound guided erector spinae plane block in the management of thoracic postherpetic neuralgia
Department of Anesthesiology and Pain medicine, Samsung Medical Center, Sungkyunkwan
University, School of Medicine, Seoul, Republic of Korea
Introduction
Postherpetic neuralgia (PHN) is a debilitating condition that is often interfering daily life of patients. Recently, several studies have reported evidence for the efficacy of erector spinae plane block (ESPB) in the management of thoracic neuropathic or postoperative pain. The resolution of neuropathic pain after ESPB suggests that both dorsal and ventral rami of thoracic spinal nerves affected by local anesthetic and it is thought to be the main mechanism of analgesia. We present a case of pain reduction after ESPB in thoracic PHN which has been showed poor response to other treatments.
Case report
A 43-year-old woman visited our pain clinic with a chronic pain of right lower thoracic region started four years ago after herpes zoster. She suffered from burning and stabbing pain with NRS from 3 to 7 out of 10, mainly at T9 dermatomes. Physical examination revealed allodynia and hyperesthesia over the affected dermatomes. She had received various medications including pregabalin, nortriptyline HCL and alprazolam and thoracic epidural steroid injections at other hospital. However, there was no significant improvement. Then, we planned an ultrasound guided thoracic ESPB at the level of T9 in the right side and performed as follows.
After finding the spinous process of T9 in a longitudinal orientation, the ultrasound moved the probe right laterally to discover the transverse process. Then, we rotated the US probe 90 degrees. As a consequence, the trapezius muscle, the latissimus dorsi muscle, the erector spinae muscle, and the transverse process were visualized (Fig 1). The 26 gauge, 2 inch needle was inserted in-plane technique until touching transverse process. We injected the 0.375% ropivacaine 25 cc in the fascial plane. There was no complication during and after the procedure.
During a follow-up of three months, she reported a significant resolution of symptoms, with a NRS from 0 to 2 out of 10, and was in good condition. Furthermore, she said that ESPB was the most effective treatment she had ever received.
Conclusion
This is the first reported case using ESPB for management of refractory PHN in pain clinic. Further controlled trials will be necessary to prove efficacy of this technique.
Reference
1. Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia. The New England journal of medicine. 2014;371(16):1526-33.
Postherpetic neuralgia (PHN) is a debilitating condition that is often interfering daily life of patients. Recently, several studies have reported evidence for the efficacy of erector spinae plane block (ESPB) in the management of thoracic neuropathic or postoperative pain. The resolution of neuropathic pain after ESPB suggests that both dorsal and ventral rami of thoracic spinal nerves affected by local anesthetic and it is thought to be the main mechanism of analgesia. We present a case of pain reduction after ESPB in thoracic PHN which has been showed poor response to other treatments.
Case report
A 43-year-old woman visited our pain clinic with a chronic pain of right lower thoracic region started four years ago after herpes zoster. She suffered from burning and stabbing pain with NRS from 3 to 7 out of 10, mainly at T9 dermatomes. Physical examination revealed allodynia and hyperesthesia over the affected dermatomes. She had received various medications including pregabalin, nortriptyline HCL and alprazolam and thoracic epidural steroid injections at other hospital. However, there was no significant improvement. Then, we planned an ultrasound guided thoracic ESPB at the level of T9 in the right side and performed as follows.
After finding the spinous process of T9 in a longitudinal orientation, the ultrasound moved the probe right laterally to discover the transverse process. Then, we rotated the US probe 90 degrees. As a consequence, the trapezius muscle, the latissimus dorsi muscle, the erector spinae muscle, and the transverse process were visualized (Fig 1). The 26 gauge, 2 inch needle was inserted in-plane technique until touching transverse process. We injected the 0.375% ropivacaine 25 cc in the fascial plane. There was no complication during and after the procedure.
During a follow-up of three months, she reported a significant resolution of symptoms, with a NRS from 0 to 2 out of 10, and was in good condition. Furthermore, she said that ESPB was the most effective treatment she had ever received.
Conclusion
This is the first reported case using ESPB for management of refractory PHN in pain clinic. Further controlled trials will be necessary to prove efficacy of this technique.
Reference
1. Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia. The New England journal of medicine. 2014;371(16):1526-33.
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