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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-03-2018 | Case Reports / Case Series

Erector spinae plane block for the management of chronic shoulder pain: a case report

Authors: Mauricio Forero, MD, FIPP, Manikandan Rajarathinam, MD, FIPP, Sanjib Das Adhikary, MD, Ki Jinn Chin, MBBS (Hons), MMed, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 3/2018

Abstract

Purpose

The erector spinae plane (ESP) block has been described in the successful management of both thoracic and abdominal pain. Since the erector spinae muscle extends to the cervical spine, the ESP block may be potentially useful in painful conditions of the shoulder girdle.

Clinical features

We performed a series of ESP blocks at the T2/T3 level in an elderly male patient with chronic shoulder pain. Immediate and profound analgesia with improved range of motion was consistently observed following the block. There was detectable sensory block in the congruent cervico-thoracic dermatomes with no motor block. Computed tomography imaging showed the spread of radiocontrast up to the C3 level in the vicinity of the neural foramina. Clinical analgesia generally outlasted the expected duration of conduction blockade and significantly contributed to overall improvement in the patient’s symptoms.

Conclusions

The ESP block may be a promising alternative to other interventional procedures in the management of chronic shoulder pain and deserves further study.

Kuijpers T, van der Windt DA, van der Heijden GJ, Bouter LM. Systematic review of prognostic cohort studies on shoulder disorders. Pain 2004; 109: 420-31.CrossRefPubMed

Peng PW, Cheng P. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part III: shoulder. Reg Anesth Pain Med 2011; 36: 592-605.CrossRefPubMed

Pourcho AM, Colio SW, Hall MM. Ultrasound-guided interventional procedures about the shoulder: anatomy, indications, and techniques. Phys Med Rehabil Clin N Am 2016; 27: 555-72.CrossRefPubMed

Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-7.CrossRefPubMed

Forero M, Rajarathinam M, Adhikary S, Chin KJ. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: a case series. Scand J Pain 2017. DOI: https://doi.org/10.1016/j.sjpain.2017.08.013.PubMed

Muñoz F, Cubillos J, Bonilla AJ, Chin KJ. Erector spinae plane block for postoperative analgesia in pediatric oncological thoracic surgery. Can J Anesth 2017; 64: 880-2.CrossRefPubMed

Chin KJ, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: a report of 3 cases. Reg Anesth Pain Med 2017; 42: 372-6.CrossRefPubMed

Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017; 72: 452-60.CrossRefPubMed

Restrepo-Garces CE, Chin KJ, Suarez P, Diaz A. Bilateral continuous erector spinae plane block contributes to effective postoperative analgesia after major open abdominal surgery: a case report. AA Case Rep 2017. DOI: https://doi.org/10.1213/XAA.0000000000000605.

10.

Chaudhury S, Gwilym SE, Moser J, Carr AJ. Surgical options for patients with shoulder pain. Nat Rev Rheumatol 2010; 6: 217-26.CrossRefPubMed

11.

Sherman SL, Khazai RS, James CH, Stoker AM, Flood DL, Cook JL. In vitro toxicity of local anesthetics and corticosteroids on chondrocyte and synoviocyte viability and metabolism. Cartilage 2015; 6: 233-40.CrossRefPubMedPubMedCentral

12.

Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med 2015. DOI: https://doi.org/10.1177/2325967115581163.PubMedPubMedCentral

13.

Wildsmith JA, Brown DT, Paul D, Johnson S. Structure-activity relationships in differential nerve block at high and low frequency stimulation. Br J Anaesth 1989; 63: 444-52.CrossRefPubMed

14.

Gissen AJ, Covino BG, Gregus J. Differential sensitivity of fast and slow fibers in mammalian nerve. III. Effect of etidocaine and bupivacaine on fast/slow fibers. Anesth Analg 1982; 61: 570-5.PubMed

15.

Ford DJ, Raj PP, Singh P, Regan KM, Ohlweiler D. Differential peripheral nerve block by local anesthetics in the cat. Anesthesiology 1984; 60: 28-33.CrossRefPubMed

16.

Chang KV, Hung CY, Wu WT, Han DS, Yang RS, Lin CP. Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2016; 97: 1366-80.CrossRefPubMed

17.

Kitayama M, Wada M, Hashimoto H, Kudo T, Takada N, Hirota K. Effects of adding epinephrine on the early systemic absorption kinetics of local anesthetics in abdominal truncal blocks. J Anesth 2014; 28: 631-4.CrossRefPubMed

18.

El-Boghdadly K, Chin KJ. Local anesthetic systemic toxicity: continuing professional development. Can J Anesth 2016; 63: 330-49.CrossRefPubMed

Title: Erector spinae plane block for the management of chronic shoulder pain: a case report
Authors: Mauricio Forero, MD, FIPP
Manikandan Rajarathinam, MD, FIPP
Sanjib Das Adhikary, MD
Ki Jinn Chin, MBBS (Hons), MMed, FRCPC
Publication date: 01-03-2018
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 3/2018
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-017-1010-1

At a glance: The STEP trials

Springer Medicine

Erector spinae plane block for the management of chronic shoulder pain: a case report

Abstract

Purpose

Clinical features

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Clinical features

Conclusions

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