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array:22 [ "pii" => "S0210573X24000674" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.101004" "estado" => "S250" "fechaPublicacion" => "2025-01-01" "aid" => "101004" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:17 [ "pii" => "S0210573X24000601" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100997" "estado" => "S250" "fechaPublicacion" => "2025-01-01" "aid" => "100997" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Update on second trimester ultrasound scanning in pregnancy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización en el protocolo de estudio en la ecografía del segundo trimestre de la gestación" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2500 "Ancho" => 1412 "Tamanyo" => 360513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Biometry and anatomical landmarks in the second trimester ultrasound. Section I: Transthalamic view (a) for measurement of BPD and HC; Abdominal plane (b) for measurement of AC; Fémur length plane (c) for measurement of FL. BPD: biparietal diameter; HC: head circumference; AC: abdominal circumference; FL: femur length. Section II: Head (a–c): using axial plane to for basic neurosonography. (a) Tranventricular plane. (b) Transthalamic plane. (c) Transcerebellar plane; face and neck (d–f, j): Using axial and coronal plane to explore face, maxilla, lips and head profile; Thorax (g–i): Using axial and sagittal planes to visualise situs, lungs, thorax and ribs and explore the integrity of diafragma. Section III: Spine: Using axial sweep, coronal and sagital planes (a–c); Abdomen: Using axial planes to explore stomach, umbilical vein, gallbladder, cord insertion, kidneys and bladder (b, d, e, f); Genital: axial or sagital planes (i); Extremities: using sagital or coronal planes to visulize large bones, feet and hands (g–i).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pelayo-Delgado, E. Gómez-Montes, M. Álvaro-Navidad" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Pelayo-Delgado" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Gómez-Montes" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Álvaro-Navidad" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000601?idApp=UINPBA00004N" "url" => "/0210573X/0000005200000001/v12_202410280410/S0210573X24000601/v12_202410280410/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0210573X24000625" "issn" => "0210573X" "doi" => "10.1016/j.gine.2024.100999" "estado" => "S250" "fechaPublicacion" => "2025-01-01" "aid" => "100999" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Diagnóstico de cáncer renal metastásico en gestante a través de lesiones cutáneas: descripción de un caso clínico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnosis of Metastatic Renal Cancer in a Pregnant Woman through Cutaneous Lesions: A Case Report" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 943 "Ancho" => 1625 "Tamanyo" => 189224 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lesión cutáneas. A) Lesión nodular eritematoviolácea en hipocondrio derecho. B) Lesión nodular en muslo derecho.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ramírez Castán, M.J. Cuerva González, J.L. Bartha Rasero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ramírez Castán" ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Cuerva González" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Bartha Rasero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210573X24000625?idApp=UINPBA00004N" "url" => "/0210573X/0000005200000001/v12_202410280410/S0210573X24000625/v12_202410280410/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Management of thoracic neuropathic pain with an ESP block in a pregnant patient" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Arce Gálvez, R.E. Valencia Gómez, A. Ceballos Vejarano, J. Daes Mora, D.A. Méndez Vega" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Arce Gálvez" "email" => array:1 [ 0 => "leonardo.arce@correounivalle.edu.co" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R.E." "apellidos" => "Valencia Gómez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ceballos Vejarano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Daes Mora" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "D.A." "apellidos" => "Méndez Vega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Physical Medicine and Rehabilitation, Universidad del Valle, Cali, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anesthesiology and Reanimation, Bogota, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Family Medicine, Bogota, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Gynecology and Obstetrics, Universidad Libre, Cali, Colombia" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Pain Medicine and Palliative Care, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento del dolor neuropático torácico con un bloqueo ESP en una paciente embarazada" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 416 "Ancho" => 1207 "Tamanyo" => 60900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Erector spinae plane block (ESP) in a 23-year woman with 27.5 weeks of pregnancy. (A) Needle trajectory; (B) application of medication in the erector spine plane. Arrow: needle.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The erector spinae plane (ESP) block is an ultrasound-guided analgesic intervention described more than eight years ago with multiple applications in spinal pain.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">1</span></a> Different utilities of this procedure have been described, ranging from the control of postoperative thoracic symptoms to pain management of a spinal segment. This intervention, when performed at the level of the costotransverse junction between the erector spinae muscle and the intertransverse ligament. Intervening in this plane provides a potential anteroposterior diffusion that covers the ventral and dorsal branches of the spinal segments and gives its distribution in the cranial and caudal direction of different metameric levels.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">These properties make ESP an appropriate intervention when treating with a patient with neuropathic pain originating in the intercostal nerves, without this being the only alternative, since there is an arsenal of pharmacological and conservative measures that can be effective.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> However, when treating a pregnant patient, pharmacological and maternal–fetal safety considerations play a fundamental role that may limit the therapeutic indications.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> In pregnancy, many systemic analgesic drugs have the potential to harm the fetus, which makes analgesic interventionism an interesting and safe alternative in the approach to these patients.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinical case</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present the case of a 23-year-old woman, 27.5 weeks of pregnancy, with intrauterine growth restriction and low height and weight for gestational age. She consulted a high complexity university hospital, due to symptoms of one week of presentation characterized by: thoracoabdominal pain radiating from the dorsal region, of high intensity, rated on the numerical rating scale (NRS) 10/10. These pain symptoms were associated with multiple emetic episodes, with no irritative urinary symptoms. On enquiring about the patient's antecedents, she had presented fluctuating symptoms in the previous weeks, consulting different medical centers for this cause. The patient had been diagnosed with a biliary pancreatitis five months prior to the current symptoms, which required management in the intensive care unit. In the context of care, she suffered a pneumothorax secondary to a central venous catheter passage that required a closed thoracotomy, leaving a skin scar as a complication, which corresponds to the current painful dermatome. Other studies were performed to rule out other etiologies: an ultrasound of the total abdomen where a grade II right hydronephrosis was reported, with no other findings, in addition to laboratory studies such as electrolytes, liver function tests, renal function tests reported and normal amylases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The thoracoabdominal pain had begun at the time of thoracotomy with the healing of the lesion. On physical examination she presented pain in the thoracic region located on the right anterolateral side covering the right T6 to T7 dermatomes, with allodynia, without description of hyperalgesia, with a normal abdominal condition and a pregnant uterus without other disorders. Considering that she did not present an acute abdominopelvic pathology, a right intercostal neuropathy was considered as a diagnostic possibility. It was decided to perform an ESP as diagnosis and treatment of pain, due to the localization of the symptoms as well as looking for an outcome with the least number of analgesics possible. Prior to the procedure, in coordination with the obstetrics and gynecology service, an initial dose of 4<span class="elsevierStyleHsp" style=""></span>mg of intravenous morphine was administered, which reduced the pain in the NRS 8/10, but given the perinatal risk profile, an opioid-free analgesia was established; for the procedure, the concomitant use of local anesthetic and corticosteroid in the procedure was considered, given the gestational age, it was not considered a pharmacological intervention of risk for the fetus. In addition, multimodal pharmacological management was started with paracetamol 1<span class="elsevierStyleHsp" style=""></span>g orally every 8<span class="elsevierStyleHsp" style=""></span>h, hyoscine bromide 20<span class="elsevierStyleHsp" style=""></span>mg intravenous every 8<span class="elsevierStyleHsp" style=""></span>h and ondansetron 8<span class="elsevierStyleHsp" style=""></span>mg intravenous every 8<span class="elsevierStyleHsp" style=""></span>h with an NRS of 7/10 and partial improvement of emesis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The ESP procedure was performed under ultrasound guidance with a 5–15<span class="elsevierStyleHsp" style=""></span>Hz linear transducer. Initially, performing an ultrasound scan of the costal levels, the T5–T6 level was located, identifying the erector spinae plane at the level of the costotransverse junction. With direct ultrasound guidance, a Quincke 3.5 inches 18 G needle was located at the level of the interfascial plane between the erector spinae muscles and the intertransverse ligament at the T6 level, to perform a hydrodissection with 0.9% saline solution and a volume of 5 milliliters (ml), observing an adequate distribution pattern above the intertransverse ligament. Subsequently, bupivacaine 0.125%<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>betamethasone 4<span class="elsevierStyleHsp" style=""></span>mg was infiltrated, with a total volume of 20<span class="elsevierStyleHsp" style=""></span>ml (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). At the end of the procedure an ultrasound scan was performed, finding a volume distribution from T4 to T10, there were no maternal–fetal complications. After 30<span class="elsevierStyleHsp" style=""></span>min of the procedure the patient showed a 100% improvement of her symptoms corresponding to an NRS of 0/10, an evaluation was made in the following 8<span class="elsevierStyleHsp" style=""></span>h finding an NRS of 0/10 and a complete improvement of the emesis symptoms, continuing the analgesics without additional opioid requirement. In the subsequent 48, 72 and 120<span class="elsevierStyleHsp" style=""></span>h the patient presented an NRS of 1/10 in the thoracoabdominal region with control of the neuropathic symptoms and without complications, so she continued to be followed up by gynecology and obstetrics in the follow-up of her initial maternal and fetal conditions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Similar to our case, ESP blockade is a useful tool in the management of neuropathic pain, with sufficient evidence in the management of intercostal neuropathies.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> However, previous descriptions of the use of ESP in pregnant patients are summarized in the management of pain after cesarean section, as an emergency analgesic measure for urolithiasis or after infectious conditions.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">6–8</span></a> The published articles, although limited, have shown that ESP is a safe intervention in pregnant patients, without generating inadequate perinatal discharge and relieving pain in different perioperative conditions.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">7,8</span></a> This report is the first to address intercostal neuropathic pain with ESP in pregnant patients, showing a positive outcome with an adequate safety margin, in addition to expanding the indications outside of surgical procedures and in chronic pain.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this case ESP was considered instead of more selective blocks such as intercostal nerve blocks because the ESP approach requires less displacement of the needle as more than one dermatomal level is involved, in addition to having a very low complication rate and a lower possibility of pleural punctures with pulmonary complications.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> In comparison to an intercostal block, the consumption of opioid analgesics is lower and pain relief is better with ESP, which is very important in a pregnant patient.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In the intervention of this type of patients, maternal and fetal safety, and the type of drugs with which they are being intervened should always be considered. The Therapeutic Goods Administration (TGA) has a classification of drugs in gestation ranging from A, B, C, D, through X in relation to their safety and the available clinical evidence on fetal outcomes. Local anesthetics are safe during pregnancy; in the case of lidocaine, it is classified by the TGA as category B and bupivacaine as category C, and these can be used with caution, without evidence of generating fetal alterations and with a benefit that exceeds the risk.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> As for corticosteroids, they are widely used in obstetrics for pulmonary maturation and perinatal risk conditions, in the approach of a localized blockade the dispersion of the drug to the fetus is minimal, and there is no evidence of adverse effects with a single dose.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Interestingly, in the case of the improvement of nausea, it could be considered that having a history of irritation of the visceral nerve fibers due to pancreatitis, the reduction of the emetic symptom may be due to a theoretical effect on the visceral innervation, in addition to the innervation of the parietal and visceral peritoneum by somatosensory and sympathetic fibers, which may become blocked when performing an ESP. Based on this, the use of this blockade in visceral pain has been reported and in the future it could be a source of research for the improvement of visceral symptoms in populations at risk such as pregnant women.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8,13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally, we highlight the safety conditions and the technical simplicity in performing the block, which make it an interesting analgesic tool in the management of non-obstetric pain in pregnant patients with a very low impact on maternal–fetal constants and the possibility of reducing the use of different drugs, including opioid analgesics.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The erector spinae plane block is a safe and effective therapeutic tool in the management of intercostal neuropathic pain in the pregnant patient. Further studies are required to establish general safety conditions and specific indications, but it is a promising tool in cases refractory to conventional interventions.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patient consent</span><p id="par0060" class="elsevierStylePara elsevierViewall">The patient gave informed consent for the performance of the procedure and release of clinical information.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical disclosure</span><p id="par0065" class="elsevierStylePara elsevierViewall">The patient gave written informed consent for the procedure and publication.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors did not receive funding to carry out this study.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">We declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2283086" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1899363" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2283087" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1899362" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Patient consent" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical disclosure" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2024-07-31" "fechaAceptado" => "2024-09-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1899363" "palabras" => array:4 [ 0 => "Pain management" 1 => "Pregnancy" 2 => "Nerve block" 3 => "Ultrasonography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1899362" "palabras" => array:4 [ 0 => "Tratamiento del dolor" 1 => "Embarazo" 2 => "Bloqueo de nervio" 3 => "Ultrasonografía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The erector spinae plane block is a useful intervention in the management of somatic and visceral nociceptive pain at different spinal levels. Studies of its use during pregnancy are still limited, however, it has shown interesting results in the management of non-obstetric pain during pregnancy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical case</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 27.5-week pregnant woman with a history of pancreatitis and a thoracotomy with neuropathic pain at intercostal level and repeated emetic symptoms who was taken to an ESP at T6 level with a sudden improvement of her symptomatology, without side effects or maternal–fetal damage.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This is the first description of the use of ESP blockade in intercostal pain during gestation, where we highlight its clinical efficacy and maternal–fetal safety profile.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Clinical case" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del plano erector espinal (ESP, por sus siglas en inglés) es una intervención útil en el manejo del dolor nociceptivo somático y visceral a diferentes niveles espinales. Los estudios sobre su uso durante el embarazo son aún limitados, sin embargo, ha mostrado resultados interesantes en el manejo del dolor no obstétrico durante el embarazo.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una gestante de 27,5 semanas con antecedentes de pancreatitis y toracotomía con dolor neuropático a nivel intercostal y síntomas eméticos de repetición que fue llevada a una ESP a nivel de T6 con mejoría brusca de su sintomatología, sin efectos secundarios ni daño materno-fetal.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Esta es la primera descripción del uso del bloqueo de la ESP en el dolor intercostal durante la gestación, donde destacamos su eficacia clínica y perfil de seguridad materno-fetal.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 416 "Ancho" => 1207 "Tamanyo" => 60900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Erector spinae plane block (ESP) in a 23-year woman with 27.5 weeks of pregnancy. (A) Needle trajectory; (B) application of medication in the erector spine plane. Arrow: needle.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The erector spinae plane block a novel analgesic technique in thoracic neuropathic pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Forero" 1 => "S.D. Adhikary" 2 => "H. Lopez" 3 => "C. Tsui" 4 => "K.J. 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