Erector spinae plane block and altered hemostasis: is it a safe option -a case series-

BACKGROUND: We described 5 cases of uneventful administration of the erector spinae plane (ESP) block to patients with altered hemostasis. CASE: Five patients were admitted to the intensive care unit with altered hemostasis, defined by the activated partial thromboplastin time ratio or internatinal normalized ratio exceeding 1.5 times the normal value; platelet count equal to or below 80000/μl; or use of anticoagulation therapy. A multimodal analgesic regimen was used for all patients, which proved unsatisfactory and limited successful ventilator weaning, until the administration of the ESP block. Effective analgesia was observed in all patients, with at least 70% reduction in numeric pain scale scores and 83% reduction in opioid consumption, which enabled successful ventilator weaning. No neurologic or hemorrhagic complications were recorded during daily surveillance over 5 days. CONCLUSIONS: The ESP block may be a suitable regional analgesia technique for patients with altered hemostasis. Further studies are needed to support this finding.