Effective Analgesia with Erector Spinae Plane Block in a 3-Year-Old Patient Undergoing Thoracotomy: A Case Report

ESPB in a pediatric patient undergoing thoracotomy.

Abstract

Introduction:

Thoracotomy is associated with significant postoperative pain in pediatric patients. Inadequately managed postoperative pain can lead to complications such as atelectasis and pneumonia due to impaired deep breathing and coughing, and insufficient analgesia within the first 24 hours may increase the risk of developing chronic pain. We present a pediatric patient who underwent thoracotomy and whose postoperative pain was managed with an erector spinae plane block (ESPB).

Case Presentation:

After obtaining informed consent from the patient's parents, the patient was taken to the operating room, where standard monitoring was applied. Anesthesia was induced with 2 mg/kg propofol, 1 μg/kg remifentanil, and 0.5 mg/kg rocuronium. Two minutes after induction, the patient was intubated with a 4 mm internal diameter endotracheal tube.

At the end of the 120-minute surgical procedure, ultrasound guidance was used to identify the erector spinae muscle and transverse processes at the T5 thoracic vertebral level. Using the in-plane technique in a cranio-caudal direction, 10 mL of 0.25% bupivacaine was injected into the fascial plane between the erector spinae muscle and the transverse process.

At the second postoperative hour, the patient was awake and cooperative; the FLACC (Face, Legs, Activity, Cry, Consolability) pain score was recorded as 1.

Discussion:
Postoperative pain management following thoracotomy is most commonly achieved using thoracic epidural or paravertebral catheters; however, both techniques carry significant risks and are technically challenging to perform in pediatric patients.

Conclusion:
This case suggests that the erector spinae plane block (ESPB) may be an effective analgesic technique in pediatric thoracic surgeries.