ERECTOR SPINAE PLANE BLOCK IN PATIENTS UNDERGOING DOUBLE PORT MEDICAL THORACOSCOPY; A TRUMP CARD FOR THE PAIN PHYSICIAN IN CRITICAL CARE


Background
Pleural diseases are frequently encountered problem in critically ill patients. Thoracoscopy is  useful and necessary for diagnosis, maximizing diagnostic yield and also for the treatment of pleural diseases. Conventionally, it is done under conscious sedation and local anaesthesia(LA). Acute pain following the procedure has been expressed as one of the major concern. Block is not an often tried option therefore ,we evaluated the efficacy of erector spinae plane block for intraoperative and post operative analgesia in 2 patients undergoing medical thoracoscopy. 

Method

The block was performed with sterile technique and deep to the erector spinae muscles in a left lateral decubitus position, Ultrasound views of the T5 transverse process were obtained in the sagittal plane using a linear, high-frequency transducer (Edge HLF50  5-16 Mhz; Sonosite Inc), Care was taken to ensure needle-tip placement within the ESP by watching for a lenticular spread of LA on injection. A total of 30 mL of 0.5% ropivacaine and 50 micrograms dexmedetomidine was injected into the ESP. 
Perioperative intravenous  benzodiazepine and  opioid requirements along with VAS scores were noted at 1 hour, 4 hours, 8 hours and 24 hours post procedure. 




 Result
The average benzodiazepine requirement of 2 mg midazolam and the average intravenous fentanyl requirement was 25 micrograms. Average VAS scores were 30, 20, 10 and 10 at 1 hour, 4 hours, 8 hours and 24 hours post procedure respectively.

Conclusion 
Erector spinae plane block is a highly effective in providing analgesia for medical thoracoscopy with substantially reduced systemic opioid need.