BAŞAK ALTIPARMAK, Melike KORKMAZ TOKER, Ali İhsan UYSAL, Semra GÜMÜŞ DEMİRBİLEK

Erector spinae plane block for anesthesia of open ventral hernia repair in severe ankylosing spondylitis

Ankylosing spondylitis (AS) is a challenging disease for anesthesiologist due its airway and axial skeleton involvement. A55-year-old male patient suffering from severe AS, admitted to anesthesiology clinic. He was planned to receive a midlineopen ventral hernia repair. We decided to perform bilateral ultrasound-guided erector spinae plane (ESP) block at the level ofT8 with 0.4 mcg kg-1 hour-1 dexmedetomidine sedation for complete anesthesia of the surgery. We performed ESP block with25 mL of 0.25% bupivacaine and repeated the same procedure at the contralateral side. Twenty minutes later, the skin incisionwas started. We did not need to apply an additive anesthetic or analgesic drug throughout the surgery. ESP block providesanalgesia for different dermatomes by effecting ventral rami and rami communicantes of spinal nerves depending on the levelof injection site. When performed between T7 and T9 levels, it has been reported to effectively attenuate post-operative painafter different types of surgeries.

Ciddi ankilozan spondilitte açık ventral herni tamirinin anestezisi için erektör spina alan bloğu

Ankilozan spondilit, havayolu ve aksiyel iskelet tutulumu nedeniyle anestezistler açısından zorlu bir hastalıktır. Ciddi ankilozan spondilit yakınması olan 55 yaşındaki bir erkek hasta Anesteziyoloji kliniğine başvurdu. Orta hat açık ventral herni onarımı planlanmıştı. Ameliyatın tam anestezisi için 4 mcg kg-1 saat-1 dexmedetomidine sedasyonu ile birlikte T8 seviyesinden bilateral ultrason rehberlikli erektor spina alan (ESP) bloğu yapmaya karar verdik. ESP bloğunu 25 mL %0,25 bupivakain ile yaptık ve aynı işlemi karşı tarafta tekrar ettik. Yirmi beş dakika sonra cilt insizyonu başladı. Operasyon boyunca ek bir anestezik veya analjezik ajan uygulamaya gerek duymadık. ESP bloğu, enjeksiyon seviyesine göre spinal sinirlerde ventral rami ve komünikan ramiyi etkileyerek, farklı dermatomlarda analjezi sağlar. T7-T9 seviyeleri arasından uygulandığında, farklı tipte ameliyatlardan sonra etkili şekilde postoperatif ağrıyı azalttığı bildirilmiştir.

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1. Li JM, Zhang XW, Zhang Y, Li YH, An JG, Xiao E, et al. Ankylosing spondylitis associated with bilateral ankylosis of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116(6):e478–84. [CrossRef ]

2. Hermann KG, Althoff CE, Schneider U, Zühlsdorf S, Lembcke A, Hamm B, et al. Spinal changes in patients with spondyloarthritis: Comparison of MR imaging and radiographic appearances. Radiographics 2005;25(3):559–69; discussion 569–70. [CrossRef ]

3. Altıparmak B, Uysal Aİ, Dede G, Turan M, Uğur B. Paravertebral block for the anesthetic management in a patient with severe ankylosing spondylitis: Single injection or multiple injections? J Clin Anesth 2018;44:5–6. [CrossRef ]

4. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block. Reg Anesth Pain Med 2016;41(5):621– 7. [CrossRef ]

5. Altıparmak B, Toker MK, Uysal Aİ, Turan M, Demirbilek SG. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth 2019;54:61–5. [CrossRef ]

6. Tulgar S, Selvi O, Kapakli MS. Erector spinae plane block for different laparoscopic abdominal surgeries: Case series. Case Rep Anesthesiol 2018;2018:3947281. [CrossRef ]

7. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth 2018;49:101–6. [CrossRef ]

8. Tulgar S, Thomas DT, Deveci U. Erector spinae plane block provides sufficient surgical anesthesia for ileostomy closure in a high-risk patient. J Clin Anesth 2018;48:2–3. [CrossRef]

9. Fields AC, Gonzalez DO, Chin EH, Nguyen SQ, Zhang LP, Divino CM. Laparoscopic-assisted transversus abdominis plane block for postoperative pain control in laparoscopic ventral hernia repair: A randomized controlled trial. J Am Coll Surg 2015;221(2):462–9. [CrossRef ]

10. Chesov I, Belii A. Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: A prospective, randomized, controlled clinical trial. Rom J Anaesth Intensive Care 2017;24(2):125–32. [CrossRef ]

11. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. Anesth Analg 2007;104(1):193–7.

12. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: A clinical practice guideline from the American pain society, the American society of regional anesthesia and pain medicine, and the American society of anesthesiologists’ committee on regional anesthesia, executive commi. J Pain 2016;17(2):131–57. [CrossRef ]