Safe and Effective Use of Bilateral Erector Spinae Block in Patient Suffering from Post-Operative Coagulopathy Following Hepatectomy

Patient: Male, 75-year-old Final Diagnosis: Cholangiocarcinoma Symptoms: Postoperative pain Medication:— Clinical Procedure: Continuous erector spinae nerve block Specialty: Oncology OBJECTIVE: Unusual clinical course BACKGROUND: Regional nerve blocks ideally provide safe and effective post-operative pain control, decrease opiate requirements, and enhance recovery from intense pain following major thoracic, abdominal, and musculoskeletal surgeries. The erector spinae plane block, a recently described novel treatment for chronic neuropathic pain and acute pain after thoracic surgery, can be performed with in plane infiltration and placement of a continuous infusion catheter deep to the erector spinae muscle at the tip of the transverse process, resulting in diffusion of local anesthetic between vertebrae and the paravertebral space with sensory blockade of spinal nerves as well as sympathetic branches. CASE REPORT: We describe the novel use of the erector spinae block for primary pain control and uncomplicated catheter removal in the setting of anticoagulation following a major hepatectomy for intrahepatic cholangiocarcinoma. The use of the erector spinae block in this context provided effective post-operative analgesia. CONCLUSIONS: Additional evidence from clinical trials will be helpful to evaluate the role of this relatively new block for peri-operative analgesia.