234 Continuous erector spinae plane block for pain management in open resection of locally recurrent renal cell carcinoma – a case-report

Background and Aims Main issues in postoperative pain management for patients with single kidney include drug dose adjustment and further damage avoidance. Originally described for thoracic analgesia1, the erector spinae plane block (ESPB) can provide abdominal somatic and visceral analgesia2,3 and circumvent limitations in these patients. We describe the successful use of a continuous ESPB to provide effective perioperative analgesia for renal fossa surgery. Methods A 79-year-old woman, ASA III, who underwent right nephrectomy due to renal cell carcinoma 4 years before, presented to the operating room for an open resection of renal-bed carcinoma recurrence (subhepatic and abdominal wall). Following general anaesthesia induction, an ultrasound-guided ipsilateral ESPB at T9 level (with 20 ml ropivacaine 0,5%) was performed and a catheter was inserted under ultrasound vision. During surgery IV dexamethasone 4 mg, fentanyl 0,05 mg, paracetamol 1g and tramadol 50 mg were administered. For postoperative pain management we elected IV paracetamol and a ropivacaine 0,2% ESPB patient-controlled-analgesia device. Results Patient underwent surgery uneventfully (mean arterial pressure 68–75 mmHg and heart rate 55–68/min). She was comfortable after the procedure and safely discharged from anesthesia care. The catheter was used for 2 days and pain was described as ‘none’ (at rest) or ‘mild’ (at movement) during vigilance. No rescue opioid was administered. Patient was satisfied with the approach and no postoperative complications were observed. Conclusions The ESPB appears to be a useful alternative to epidural, paravertebral block or IV strategies for pain management in moderately aggressive retroperitoneal surgeries, with optimal safety profile and extent of sensitive coverage.