Application of Erector Spinae Plane Block in a Cognitively Disabled Scoliosis Adolescent Patient: a Case Report

Abstract

Analgesic requirement for the patients undergoing posterior stabilization and instrumentation surgery is important during preoperative and postoperative periods. Erector spinae plane (ESP) block has come into question in recent years for opioid-free anesthesia and also for postoperative analgesia. In this paper, we present a bilateral bi-level ESP blocks practice for a 15-year-old phenylketonuric and cognitively disabled scoliosis adolescent boy, which is the first study in the open literature to the best of our knowledge. We planned a bilateral bi-level ESP block practice for the adolescent patient scheduled to undergo the posterior instrumentation surgery involving 12 vertebral level (T3-L2). Bilateral single-injection ESP block was performed at two levels (T5 and T7) prior to incision. Intraoperatively, patient received intravenous propofol and remifentanyl infusions which were administered as total intravenous anesthetic (TIVA) agents. FLACC (face, legs, activity, cry, consolability) scale was used to follow analgesic requirement postoperatively. The analgesic need was extremely low during postoperative 24-h follow-up, and a safe postoperative analgesia was provided for the opioid side effect-free patient. Bilateral bi-level ESP block is an easily applicable and a safe technique which could be chosen for cognitively disabled scoliosis adolescent patients as a part of multimodal analgesic regimen to avoid side effects of opioids and other invasive techniques.