Erector spinae plane and intra thecal opioid (ESPITO) analgesia in radical nephrectomy utilising a rooftop incision: novel alternative to thoracic epidural analgesia and systemic morphine: a case series

Author:

Ratnayake Ashani1,Goh Lihxuan2,Woolsey Lee2,Thawale Roshan3,Jackson Benjamin L.4,Niraj G.5

Affiliation:

1. Speciality Doctor in Anaesthesia , University Hospitals of Leicester NHS Trust , Leicester , UK

2. Core Trainee in Anaesthesia , University Hospitals of Leicester NHS Trust , Leicester , UK

3. Specialist Trainee in Anaesthesia , University Hospitals of Leicester NHS Trust , Leicester , UK

4. Consultant in Urological Surgery , University Hospitals of Leicester NHS Trust , Leicester , UK

5. Consultant in Anaesthesia and Pain Medicine, Clinical Research Unit of Pain Medicine, Honorary Senior Lecturer , University of Leicester, University Hospitals of Leicester NHS Trust , Gwendolen Road , Leicester LE5 4PW , UK

Abstract

Abstract Background Open radical nephrectomy and inferior vena cava exploration through a roof top incision involves significant peri-operative morbidity including severe postoperative pain. Although thoracic epidural analgesia provides excellent pain relief, recent trends suggest search for effective alternatives. Systemic morphine is often used as an alternative analgesic technique. However, it does not provide dynamic analgesia and can often impede recovery in patients undergoing major surgery on the abdomen. The authors present the first report of a novel analgesic regimen in this cohort with good outcomes. Methods Five patients undergoing open radical nephrectomy and inferior vena cava exploration received erector spinae plane infusion and intra thecal opioid analgesia at a tertiary care university teaching hospital. Outcomes included dynamic analgesia, length of hospital stay and complications Results Five adult patients undergoing major upper abdominal surgery, who refused thoracic epidural analgesia, received erector spinae plane infusion and intrathecal opioid analgesia. Patients reported effective dynamic analgesia, minimal use of rescue analgesia, early ambulation and enhanced recovery. Conclusion The novel regimen that avoids both epidural analgesia and systemic morphine can be an option in enabling enhanced recovery in this cohort.

Publisher

Walter de Gruyter GmbH

Subject

Anesthesiology and Pain Medicine,Clinical Neurology

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