What is it about?
Pediatric liver transplantation presents a number of anesthetic challenges, especially in providing adequate perioperative analgesia. We describe pre-incisional bilateral Erector Spinae Plane catheter placement in two pediatric patients undergoing orthotopic liver transplantation. This regional technique resulted in good analgesia, markedly reduced intraoperative and post-operative opioid consumption, and was associated with rapid return of bowel function.
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Why is it important?
Pain control is a vital part of care for patients presenting for pediatric liver transplantation but can be difficult to achieve. We describe the impact of the use of continuous regional analgesia via Erector Spinae Plane (ESP) Catheters on pain control and functional recovery for pediatric liver transplant recipients. The technique resulted in good pain control, a dramatic reduction in the use of opioid pain medicines and a rapid return of bowel function. The article also clearly states local guidelines for the placement of ESP in the setting of coagulopathy. The ability to provide regional analgesia for coagulopathic patients, including children, could improve outcomes and pain control in many settings.
Perspectives
Pain control is a vital aspect of peri-operative care as it can improve the patient experience, promote a return to normal function and blunt the detrimental response to surgical stress. This is especially true for complex interventions such a pediatric liver transplantation. The ability to provide continuous regional analgesia to children presenting for liver transplant has been limited due to concerns about coagulopathy and the large surgical field. Erector Spinae Plane (ESP) blockade is an emerging technique that allows for spread of blockade across a large distribution via injection at a superficial and compressible site. This profile should allow for it's application in the setting of pediatric liver transplantation. We report it's successful application for two cases and describe guidelines for the placement of a block in the setting of abnormal coagulation profiles.
robert moore
Washington University in Saint Louis
Read the Original
This page is a summary of: Early experiences with the use of continuous erector spinae plane blockade for the provision of perioperative analgesia for pediatric liver transplant recipients, Regional Anesthesia & Pain Medicine, April 2019, BMJ,
DOI: 10.1136/rapm-2018-100253.
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