Dear Editor,Erector Spinae Plane Block (ESPB from now on) is a technique introduced in clinical practice by Forero et al.,[1] in which local anesthetic is injected between the erector spinae muscle and transverse process. This block affects the dorsal and ventral rami of the thoracic and abdominal spinal nerves. ESPB can be performed at thoracic or lumbar level, making it feasible for breast, thoracic, abdominal, and orthopedic surgery.Some studies suggest its use in nephrectomies; thus increasing its already astonishing potential, for instance, Canturk[2] and Kim et al.,[3] recommend it for analgesia following renal surgery in adults, as well as Aksu and Gürkan[4] in pediatric patients. Last, Santonastaso et al.[5] tried to provide intraoperative and postoperative analgesia through ESPB to a patient undergoing open partial nephrectomy.This amount of literature suggested us to try ESPB to manage intraoperative and postoperative pain in two patients undergoing laparoscopy nephrectomy. This technique is minimally invasive, so when compared to the open technique it presents less postoperative pain and shorter length of stay. We noticed, in addition, that in this surgery pain is well localized, with an almost band-like distribution; that's why spinal anesthesia may block more dermatomes than necessary. ESPB could represent a good compromise between pain management and this kind of overtreatment.The patients we chose to manage with this technique were both overweight (BMI 31 and 34); the block was performed at T9 level, using a convex ultrasound probe to identify the transverse processes [Figure 1]; patients were lying on the side not to operate and, using an in-plane technique with an echogenic needle, 20 ml of 0.5% ropivacaine were injected deep to the fascial plane of the muscle.
Figure 1
Identification of the transverse process of T9 and needle direction
Identification of the transverse process of T9 and needle directionWhat we wanted to obtain was a decrease in invasivity and in the amount of opioids administered, both during and after surgery.During surgery, both patients stayed stable from the hemodynamic point of view; no complications occurred, and both were back in their room after less than an hour in our recovery room.For the first patient, highest NRS was 2, and pain was well controlled with paracetamol.The second patient had highest NRS in postoperative period of 3. He was treated with paracetamol, too, because it was enough to soothe the pain.ESPB allowed us to spare opioids, making a mini-invasive procedure like laparoscopic nephrectomy even less invasive. The patients' length of stay was reduced, and they both reported comfort and satisfaction with their postoperative period.Of course, analysis of two patients cannot reach statistical significance. Further studies are needed, but we believe that our experience gives us a hint about the increasing potential of ESPB in practical clinic.
Figure 1