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array:24 [ "pii" => "S2341192918300532" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.006" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "885" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:287-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617302694" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.11.010" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "885" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:287-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 121 "formatos" => array:2 [ "HTML" => 78 "PDF" => 43 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Bloqueo continuo en el plano del músculo erector del espinal para analgesia en cirugía torácica pediátrica: informe de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "290" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Continuous erector spinae plane block for analgesia in pediatric thoracic surgery: 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" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2471 "Ancho" => 1583 "Tamanyo" => 255354 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A. Bloqueo en el plano del erector del espinal practicado en el nivel del proceso transverso (TP) de T5. La aguja se inserta en el plano, tras identificar las 3 capas musculares (músculo trapecio [TM], músculo romboide mayor [RMM] y músculo erector del espinal [ESM]),en la dirección del proceso transverso de T5. B. Inserción de catéter 22<span class="elsevierStyleHsp" style=""></span>G (*) bajo visión directa a 4<span class="elsevierStyleHsp" style=""></span>cm por encima de la punta de la aguja.</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">LA: anestésico local.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Gaio-Lima, C.C. Costa, J.B. Moreira, T.S. Lemos, H.L. Trindade" "autores" => array:5 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Gaio-Lima" ] 1 => array:2 [ "nombre" => "C.C." "apellidos" => "Costa" ] 2 => array:2 [ "nombre" => "J.B." "apellidos" => "Moreira" ] 3 => array:2 [ "nombre" => "T.S." 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"apellidos" => "Trindade" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300532" "doi" => "10.1016/j.redare.2018.04.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300532?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302694?idApp=UINPBA00004N" "url" => "/00349356/0000006500000005/v1_201805080427/S0034935617302694/v1_201805080427/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918300490" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.003" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "891" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:291-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "291" "paginaFinal" => "293" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemotórax masivo derecho por rotura espontánea idiopática de una arteria frénica tras cirugía cardiaca" ] ] "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" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1271 "Ancho" => 2333 "Tamanyo" => 267514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced computed tomography. Active intrathoracic bleeding in the right hemithorax (white arrow) with significant haemothorax and clots that displaced liver and right kidney.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Taboada Muñiz, A. Tubio Pose, E. Ferreiroa Mosquera, A. Calvo Rey, J.M. Martínez Cereijo, J. Alvarez Escudero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Taboada Muñiz" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tubio Pose" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Ferreiroa Mosquera" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Calvo Rey" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez Cereijo" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Alvarez Escudero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S003493561730275X" "doi" => "10.1016/j.redar.2017.12.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493561730275X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300490?idApp=UINPBA00004N" "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300490/v1_201805120427/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300489" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.04.002" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "881" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:284-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Erector spinae plane block for analgesia after lower segment caesarean section: Case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "284" "paginaFinal" => "286" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo del plano del erector del espinal para analgesia tras cesárea del segmento inferior: informe de caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Yamak Altinpulluk, D. García Simón, M. Fajardo-Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Yamak Altinpulluk" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "García Simón" ] 2 => array:2 [ "nombre" => "M." 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Gaio-Lima, C.C. Costa, J.B. Moreira, T.S. Lemos, H.L. Trindade" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Gaio-Lima" "email" => array:1 [ 0 => "claratgl@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "C.C." "apellidos" => "Costa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.B." "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "T.S." "apellidos" => "Lemos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "H.L." "apellidos" => "Trindade" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Anestesiología, Hospital do Divino Espírito Santo de Ponta Delgada, EPE, São Miguel, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología, Centro Hospitalar São João, EPE, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anestesiología, Critical Care & Emergency Medicine, Centro Hospitalar do Porto, EPE, Porto, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anestesiología, Centro Hospitalar de Lisboa Central/Hospital Dona Estefânia, Lisboa, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo continuo en el plano del músculo erector del espinal para analgesia en cirugía torácica pediátrica: informe de un caso" ] ] "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" => 1267 "Ancho" => 1267 "Tamanyo" => 167299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patient in left lateral decubitus with landmarking marks. T5–T5 spinous process; T7–T7 spinous process; arrow–tip of the scapula; A–site for probe placement in a longitudinal parasagittal orientation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The erector spinae plane block (ESP) is an emerging ultrasound-guided deep plane interfascial block that has been shown to provide thoracic and abdominal analgesia.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> When injected at the T5 transverse process level, the local anesthetic spreads anteriorly through the thoracolumbar fascia and reaches the ventral and dorsal rami of the spinal nerves and posteriorly to the gray and white rami communicantes of the sympathetic chain, providing a C7 to T8 sensitive block.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Although it was first described as a chronic pain block, there are increasingly reports about its use in postoperative acute pain.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">First-line regional analgesia for thoracotomy procedures includes thoracic epidural or paravertebral blocks.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The novel erector spinae block may be a valid alternative.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the first description of a continuous erector spinae muscle block performed for pediatric thoracic surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 15-month-old boy, weighing 11<span class="elsevierStyleHsp" style=""></span>kg, American Society of Anesthesiologists (ASA) physical status III, with a paracardiac thoracic trigeminal teratoma (55<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>mm) was scheduled for tumor resection with a thoracotomy approach. Laboratory findings were within normal range and there was no respiratory compromise at the time of surgery. An MRI revealed an ovulated formation with adipose, soft tissue and cystic components in the right hemithorax, measuring 55<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>44<span class="elsevierStyleHsp" style=""></span>mm, globally well circumscribed, in close contact with the mediastinal pleura. The anesthetic procedures were explained and parental informed consent for the anesthetic procedure was obtained prior to surgery. Later, in the post-operative period, we obtained parental consent for this case report.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After arriving in the operating room, general anesthesia was induced with propofol (3<span class="elsevierStyleHsp" style=""></span>mg/kg), fentanyl (4.5<span class="elsevierStyleHsp" style=""></span>μg/kg) and cisatracurium (0.2<span class="elsevierStyleHsp" style=""></span>mg/kg), and an orotracheal tube was placed by direct laringoscopy, and bilateral ventilation confirmed by auscultation. For the block placement, the patient was placed in left lateral decubitus position. A high-frequency (12<span class="elsevierStyleHsp" style=""></span>MHz) linear GE<span class="elsevierStyleSup">®</span> ultrasound transducer was placed in a parassagital orientation, 2<span class="elsevierStyleHsp" style=""></span>cm lateral to the T5 spinous process (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After identifying the three muscular layers (trapezius, rhomboid major and erector spinae muscles), a 20-gauge 50-mm Tuohy needle (BBraun<span class="elsevierStyleSup">®</span>) was inserted in a cephalad to caudal direction until the tip made contact with the T5 transverse process (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a), in the fascial plane on the deep aspect of erector spinae muscle, as evidenced by visible linear spread of anesthetic between the surface of the transverse process and the erector spinae muscle. A total of 5<span class="elsevierStyleHsp" style=""></span>ml (0.45<span class="elsevierStyleHsp" style=""></span>ml/kg) of ropivacaine 0.2% was injected,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> followed by the placement of a 22-gauge catheter under real-time ultrasound guidance 4<span class="elsevierStyleHsp" style=""></span>cm beyond the needle tip (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b), and the catheter skin exit-site was secured with a topical skin adhesive (liquiband flex<span class="elsevierStyleSup">®</span>). No local analgesic adjuncts were administered during surgery. Anesthesia was maintained with sevoflurane (MAC 1.2) in an oxygen–air mixture (FiO<span class="elsevierStyleInf">2</span> 0.40), and a multimodal analgesia regimen was achieved with 7.5<span class="elsevierStyleHsp" style=""></span>mg/kg of intravenous acetaminophen. The surgical procedure lasted 90<span class="elsevierStyleHsp" style=""></span>minutes and included a right posterolateral thoracotomy at the 5th intercostal space level, with excision of the trigeminal teratoma and insertion of a chest drain at the 6th intercostal space level. Hemodynamic and respiratory stability were maintained throughout the procedure. The patient was extubated at the end of surgery and transferred to the intensive care unit (ICU) for further monitoring. In the ICU, continuous interfascial infusion of ropivacaine 0.1% at a rate of 2<span class="elsevierStyleHsp" style=""></span>ml/hour was initiated 2<span class="elsevierStyleHsp" style=""></span>hours after the initial bolus, along with scheduled intravenous acetaminophen 7.5<span class="elsevierStyleHsp" style=""></span>mg/kg every 6<span class="elsevierStyleHsp" style=""></span>hours, and intravenous ketorolac (0.5<span class="elsevierStyleHsp" style=""></span>mg/kg) and metamizole (20<span class="elsevierStyleHsp" style=""></span>mg/kg) for rescue analgesia. The FLACC (Face, Legs, Activity, Cry, Consolability) behavioral pain assessment scale was used to assess postoperative pain.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The FLACC score was 6/10 on transfer to the ICU, and decreased to 2/10 after rescue analgesia was administered. The patient was reassessed 6, 24 and 48<span class="elsevierStyleHsp" style=""></span>hours after the procedure, remaining with a FLACC score of 2/10 (1 point for cry and 1 point for consolability). Ropivacain 0.1% perfusion was maintained at 2<span class="elsevierStyleHsp" style=""></span>ml/hour for 50<span class="elsevierStyleHsp" style=""></span>h and then stopped; no further rescue boluses were needed. No opioid analgesic was ever required. No respiratory insufficiency, mobilization impediment or regional autonomic block manifestations were observed. The patient was discharged to the ward the next day and home 3 days later. A week later, in the follow-up consultation, he remained asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Thoracotomy is one of the most painful surgical procedures, and inadequate pain management can lead to prolonged ICU stay, delayed return to daily activities, increased pulmonary complications and chronic persistent postsurgical pain (postthoracotomy syndrome).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> One of the factors that has been thought to influence the occurrence of postthoracotomy syndrome is the intensity of postoperative pain.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> For this reason, it is essential to establish an effective analgesic plan. Regional anesthetic techniques are strongly recommended, as their opioid-sparing effect reduces the risk of opioid-related adverse effects such as nausea, vomiting, hypoventilation and sedation.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Thoracic epidural analgesia and thoracic paravertebral block are the first line techniques for the management of acute thoracic postoperative pain. If contraindicated, intercostal nerve block associated with multimodal analgesia is thought to be a good alternative.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The ESP block is a recent technique that has shown promising results in the management of postoperative pain.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The ESP block was first described in 2016, and so far less than 20 cases been reported in the literature. The block's sonoanatomy and the target for local anesthetic administration make it a simple and safe block to perform, either as a single-shot or continuous technique. There is a good craniocaudal spread of local anesthetic, both from single shot administration or through a catheter, giving effective analgesia.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> The majority of cases reported involve single-shot techniques. In our hospital, we adapted the technique to pediatric patients, and we report the first case of continuous infusion in a pediatric patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this case, we choose to administer 5<span class="elsevierStyleHsp" style=""></span>ml of local anesthetic (0.45<span class="elsevierStyleHsp" style=""></span>ml/kg) at the level of T5 to ensure spread from T1 to T8 dermatome levels<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,7</span></a> and provide analgesia to the surgical area and chest drain insertion sites. We then inserted a catheter for continuous analgesia in the postoperative period.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The benefits of regional anesthesia for pediatric thoracic surgery must be carefully weighed up against its potential risks, as these blocks are usually performed under general anesthesia. Although thoracic epidural is the gold-standard for post-thoracotomy pain management, this technique, like paravertebral block, presents a potential risk for pleural or dural puncture.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> Intercostal nerve blocks can be very effective, but multiple punctures are needed analgesia, duration is limited.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Ultrasound-guided ESP block seems to be a safer technique, as the injection site is further away from the spine, major vessels and pleura.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, this was the first description of a continuous ESP block performed for pediatric thoracic surgery. Our results suggest it is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potentially greater safety of this technique. Although it was highly effective, more studies are needed to prove its efficacy in the management of acute postoperative pain in children.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1024780" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec982675" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1024779" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec982676" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-09-20" "fechaAceptado" => "2017-11-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec982675" "palabras" => array:3 [ 0 => "Continuous erector spinae plane block" 1 => "Regional anesthesia" 2 => "Pediatric anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec982676" "palabras" => array:3 [ 0 => "Bloqueo continuo en el plano del músculo erector del espinal" 1 => "Anestesia regional" 2 => "Anestesia pediátrica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erector spinae plane block has been recently described and it appears as a very promising regional analgesia technique. We report the first continuous erector spinae plane block performed in a pediatric patient for thoracic surgery.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A 15-month-old boy, diagnosed with a paracardiac teratoma was scheduled for a tumor resection with a thoracotomy approach. After general anesthesia induction, a continuous erector spinae plane block at T5 level was performed with ropivacaine 0.2%. After surgery, a continuous thoracic interfascial infusion of ropivacaine 0.1% along with multimodal rescue analgesia was initiated.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patient tolerated the procedure well with no complications. It appears that this is a good alternative to thoracic epidural and paravertebral block, given the simple reproducibility and potential greater safety of this technique.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El bloqueo en el plano del músculo erector del espinal ha sido recientemente descrito, y parece ser una técnica de analgesia regional muy prometedora. Reportamos el primer bloqueo continuo en el plano del músculo erector del espinal realizado en un paciente pediátrico sometido a cirugía torácica.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se trata de un niño de 15 meses con un teratoma paracardiaco programado para resección tumoral por toracotomía. Después de la inducción de anestesia general se practicó un bloqueo continuo en el plano del músculo erector del espinal a nivel de T5 con ropivacaína 0,2%. Tras la cirugía se inició una perfusión torácica interfascia de ropivacaína 0,1% y analgesia multimodal.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El paciente toleró bien el procedimiento sin complicaciones. Parece que esta es una buena alternativa a la epidural torácica y el bloqueo paravertebral, dada la simple reproducibilidad y la mayor seguridad potencial de esta técnica.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gaio-Lima C, Costa CC, Moreira JB, Lemos TS, Trindade HL. Bloqueo continuo en el plano del músculo erector del espinal para analgesia en cirugía torácica pediátrica: informe de un caso. Rev Esp Anestesiol Reanim. 2018;65:287–290.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1267 "Ancho" => 1267 "Tamanyo" => 167299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patient in left lateral decubitus with landmarking marks. T5–T5 spinous process; T7–T7 spinous process; arrow–tip of the scapula; A–site for probe placement in a longitudinal parasagittal orientation.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2471 "Ancho" => 1583 "Tamanyo" => 255354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">(a) Ultrasound-guided erector spinae plane block performed at the level of the T5 transverse process (TP). The needle is inserted in-plane, after identification of the three muscle layers (trapezius muscle (TM), rhomboid major muscle (RMM) and erector spinae muscle (ESM), directed to the T5 transverse process). (b) Insertion of a 22-gauge catheter (*) under direct vision 4<span class="elsevierStyleHsp" style=""></span>cm beyond the needle tip. TP–transverse process; LA–local anesthetic.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "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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