Experience of the Ultrasound-assisted Nerve Blockade of the Fascial Plane by Erector Spine Block in Acute Pancreatitis
Year: 2024
Type: conference-paper
Study design: Case Report
Abstract: Pain in the intensive care unit is a common problem in patients with acute pancreatitis of various etiologies. Given the severity of the pain syndrome, as well as the low effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodic therapy, it is often necessary to resort to the administration of opioid analgesics (OA) or epidural analgesia (EA). Each of these pain management methods has certain disadvantages and contraindications, which makes it urgent to search for a safe and effective method of relieving pain in patients with pancreatitis or pancreonecrosis. Goal: To determine the effectiveness of blockade of the fascial space of the spinal erector spinae muscle in acute pancreatitis. Clinical observation: Patient X, 58 years old, was brought to the emergency room of the SBHI “State Clinical Hospital after V.M. Buyanov” MHD with complaints of severe pain in the epigastric region (according to the visual analogue scale (VAS) 10 points out of 10). At the pre-hospital stage an attempt was made to control the pain syndrome by intravenous administration of non- steroidal anti-inflammatory drugs (NSAIDs) and OA (Sol Ketoprofeni 100 mg, Sol Tramadoli 100 mg), which, however, did not lead to the desired reduction of pain sensations. According to the data of clinical and laboratory examination the following diagnosis was made: Main: K85.1 Acute biliary pancreatitis. Complication: K86.8.1 Pancreonecrosis. Associated: K80 Gallstone disease. Given the persisting pain, at the stage of admission the patient was given an intravenous injection of Sol. Morphini 10 mg, which only slightly reduced the intensity of the pain syndrome to 8 points out of 10 on the VAS scale. Taking into account the severity of the condition, the patient was hospitalised in the intensive care unit for surgical patients. Laboratory tests showed thrombocytopenia (PLT (83*10*9) and therefore it was decided to abstain from epidural catheter placement. Alternatively, after signing a voluntary informed consent, the patient underwent ultrasound-assisted blockade of the fascial space of the erector spinae spinae muscle (ESPB) at the level of the transverse process of the 5th thoracic vertebra on the left side. The anaesthetic used was Sol. Ropivacaini 0.5% in a volume of 25 ml. Twenty minutes after the blockade was performed, the patient noted a marked regression of pain syndrome (up to 2 points out of 10 on the VAS scale), which persisted for 12 hours. After expiry of the anaesthetic, the patient again complained of an increase in pain intensity (6 points out of 10 on the VAS scale), which was controlled by intravenous injection of Sol. Ketopropheni 100 mg and intravenous administration of Sol Tramadoli 100 mg. During further follow- up the intensity of the pain syndrome did not exceed 2-3 points on the VAS scale. The total time of the patient’s stay in the hospital was 12 days, and in the intensive care unit - 2 days. Conclusion. Performing ESPB in a patient with acute biliary pancreatitis complicated by pancreatic necrosis made it possible to quickly and safely stop the pain syndrome
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: Russian Science Foundation
OpenAlex ID: W4405283633