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Luengo-Pastor, R. Guerrero-Domínguez, E.C. Navarro-Suárez, C. Rasero-Moreno" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.Á." "apellidos" => "Luengo-Pastor" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Guerrero-Domínguez" ] 2 => array:2 [ "nombre" => "E.C." "apellidos" => "Navarro-Suárez" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Rasero-Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618302329" "doi" => "10.1016/j.redar.2018.12.001" "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/S0034935618302329?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300307?idApp=UINPBA00004N" "url" => "/23411929/0000006600000003/v1_201903070610/S2341192919300307/v1_201903070610/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192919300253" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.10.003" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "977" "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). 2019;66:163-6" "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">Case report</span>" "titulo" => "Total thyroidectomy in patient with McArdle's syndrome: Anaesthetic management" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "163" "paginaFinal" => "166" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tiroidectomía total en paciente con síndrome de McArdle: manejo anestésico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.V. Quintero Salvago, J.D. Leal del Ojo del Ojo, L. Barrios Rodríguez, J.J. Fedriani de Matos, I. Morgado Muñoz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A.V." "apellidos" => "Quintero Salvago" ] 1 => array:2 [ "nombre" => "J.D." "apellidos" => "Leal del Ojo del Ojo" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Barrios Rodríguez" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Fedriani de Matos" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Morgado Muñoz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935618301919" "doi" => "10.1016/j.redar.2018.10.004" "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/S0034935618301919?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300253?idApp=UINPBA00004N" "url" => "/23411929/0000006600000003/v1_201903070610/S2341192919300253/v1_201903070610/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery – A clinical report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "167" "paginaFinal" => "171" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Brandão, R. Graça, M. Sá, J.M. Cardoso, S. Caramelo, C. Correia" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Brandão" "email" => array:1 [ 0 => "jocbrandao@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Graça" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Sá" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Cardoso" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Caramelo" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Correia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Anestesiología y Terapia del Dolor, Centro Hospitalar de Trás-Os-Montes e Alto Douro, EPE, Vila Real, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1160 "Ancho" => 1133 "Tamanyo" => 192454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ultrasound imaging of the ESPB after performing the block. Note the spread of local anaesthetic beneath the erector spinae muscle. TP – transverse process, N – needle, ESM – erector spinae muscle, LA – local anaesthetic.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spinal procedures are usually associated with moderate to severe pain in the immediate postoperative period. Adequate pain management facilitates improved functional outcome, early ambulation and discharge, and prevents the development of chronic pain.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Possible analgesic regimens include conventional intravenous pain therapy, ketamine or local anaesthetic infusions, and neuroaxial blocks. Regional techniques have numerous recognised benefits in spine surgery, including a cleaner surgical field (provided by hypotension and vasodilation due to sympathetic blockade), a more stable intraoperative haemodynamic profile, reduced blood loss and thromboembolic complications, opioid-sparing effects, and prolonged postoperative analgesia.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The erector spinae muscle extends along the length of the thoracolumbar spine. The ultrasound-guided erector spinae plane block (ESPB) at the T5 transverse process is a technique recently described by Forero et al. for thoracic analgesia. Local anaesthetic injected into the fascial plane deep to the erector spinae muscle spreads in a cranio-caudal fashion over several levels, allowing for multidermatomal coverage. It also penetrates anteromedially through the intertransverse connective tissue and enters the epidural and thoracic paravertebral space, where it can potentially block not only the ventral and dorsal rami of the spinal nerves, but also the <span class="elsevierStyleItalic">rami communicantes</span> that transmit sympathetic information.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Different applications have recently been reported in the literature, including its use in acute pain relief after abdominal<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> and thoracic surgery.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Additionally, there is a recent description of ESPB at the lumbar level providing good postoperative analgesia for total hip arthroplasty.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to its wide sensory blockade and analgesia potential, we hypothesised that ESPB at the lumbar level could be useful for several reasons; namely, intraoperative haemodynamic stability, blood loss and analgesia, and also in the control of acute postoperative pain and chronic pain development after spine surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 66-year-old female was scheduled for lumbar laminectomy and single level (L4–L5) fusion, due to spondylolisthesis. The patient's medical history included dyslipidaemia, well controlled hypertension, asthma, and overweight (weight 66<span class="elsevierStyleHsp" style=""></span>kg, height 1.58<span class="elsevierStyleHsp" style=""></span>m, body mass index 26.50<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>). She complained of chronic (>3 months) lumbar pain, which did not respond to paracetamol, NSAIDs, and physical therapy. The patient agreed to undergo surgical treatment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A brief preoperative neurological examination was performed, which showed no motor impairment of lower limbs or sensory deficits. She did not present hyperalgesia or allodynia. Pain was restricted to the lumbar area with no pain irradiation, and worsened with movement, and improved with rest. Moreover, palpation revealed some painful muscular contractures of the paravertebral muscles.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Before general anaesthesia induction, we performed a modified ultrasound guided erector spinae block at the lumbar level L4. With the patient in a sitting position, a high-frequency linear ultrasound transducer was placed in a longitudinal orientation 3<span class="elsevierStyleHsp" style=""></span>cm lateral to the L4 spinous process (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) At this level, the only muscle identified superficial to the hyperechoic transverse process is the erector spinae muscle (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A 50<span class="elsevierStyleHsp" style=""></span>mm 22<span class="elsevierStyleHsp" style=""></span>G ultrasound needle (PAJUNK<span class="elsevierStyleSup">®</span>) was inserted in-plane in a cephalad to caudal direction until bone contact with the top of the transverse process. After slight retraction of the needle, 15<span class="elsevierStyleHsp" style=""></span>ml of 0.375% ropivacaine was injected deep to the erector spinae muscle, and cephalad to caudal spread of the local anaesthetic was promptly observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The same procedure was repeated on the contralateral side.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">General anaesthesia was induced intravenously (IV) with 200<span class="elsevierStyleHsp" style=""></span>μg of fentanyl, 120<span class="elsevierStyleHsp" style=""></span>mg of propofol, and 40<span class="elsevierStyleHsp" style=""></span>mg of rocuronium. Additionally, 4<span class="elsevierStyleHsp" style=""></span>mg of IV dexamethasone were administered immediately after induction. The patient was intubated and placed in the prone position. Monitoring was performed according to American Society of Anaesthesiology standards, Bispectral Index (BIS<span class="elsevierStyleSup">®</span>), and quantitative neuromuscular blockade. Sevoflurane was the chosen inhaled agent for anaesthesia maintenance, with a 35% FiO<span class="elsevierStyleInf">2</span>:Air. The patient remained haemodynamically stable throughout the procedure. Mean arterial pressures were maintained at around 65<span class="elsevierStyleHsp" style=""></span>mmHg and heart rate around 60 beats per minute, with no need for vasopressors, hypotensive agents or additional opioids. BIS was used to guide anaesthesia depth and was maintained at around 40 with a stable and reduced MAC (maximum MAC 0.8). The patient was only given 1<span class="elsevierStyleHsp" style=""></span>g IV paracetamol intraoperatively for analgesia. The procedure lasted for approximately 3<span class="elsevierStyleHsp" style=""></span>h in the prone position, after which the patient was placed supine and uneventfully extubated after administration of 4<span class="elsevierStyleHsp" style=""></span>mg IV ondansetron and 130<span class="elsevierStyleHsp" style=""></span>mg sugammadex to reverse the neuromuscular block. The patient awoke absolutely pain-free and without nausea.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient remained in the Post Anaesthesia Care Unit for approximately 2<span class="elsevierStyleHsp" style=""></span>h before meeting discharge criteria. At that time, she was able to autonomously move to her bed with no pain or motor impairment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">An immediate postoperative neurologic assessment revealed no motor impairment of the lower extremities and an extensive sensory block to both pinprick and cold. On the back, the sensory block extended bilaterally from T10 to S2. On the front, it extended up to T8 on the left and T10 on the right from S2. This evaluation was performed every 12<span class="elsevierStyleHsp" style=""></span>h after surgery, and remained unchanged until 48<span class="elsevierStyleHsp" style=""></span>h after surgery, when the block finally receded. During this time, the patient was given 1<span class="elsevierStyleHsp" style=""></span>g IV paracetamol every 6<span class="elsevierStyleHsp" style=""></span>h and was offered a Patient Controlled Analgesia IV pump with morphine. The pump had no baseline perfusion, but allowed a bolus of 1<span class="elsevierStyleHsp" style=""></span>mg of morphine every 7<span class="elsevierStyleHsp" style=""></span>min. In the first two days after surgery, she required 6<span class="elsevierStyleHsp" style=""></span>mg of morphine per day. The postoperative period was uneventful. She remained pain-free at rest, and the maximum reported pain score with movement was mild (numeric rating score 3–4 out of 10). On the third day, the pump was removed and the patient was discharged. The patient was extremely satisfied with the analgesic strategy.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the original description of thoracic ESPB, three muscles are identified superficial to the hyperechoic transverse process shadow: trapezius, rhomboid major, and erector spinae. The trapezius muscle originates in the superior nuchal line, inion, nuchal ligament and spinous processes of C7–T12, and inserts onto the clavicle and scapula, whereas the rhomboid major muscle arises from the spinous processes of T2–5 and inserts onto the scapula. The erector spinae can be thought of as a group of three muscles that extend from the occipital region to a common insertion point in a large. broad tendon on the back of the sacrum, the inner side of the iliac crest, sacroiliac ligaments, and lumbosacral spinous processes. Given this, only the erector spinae muscle can be identified at the lumbar level superficial to the transverse processes, covered by the thoracolumbar fascia. The erector spinae's relationship with the paravertebral space and neighbouring structures does not change from the thoracic to lumbar region, justifying the block's feasibility at the lumbar level.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The ESPB is an effective, simple and safe analgesic technique with numerous applications, particularly when compared to paravertebral block and epidural analgesia techniques, with their well-known risks and side effects. The patient was pain-free and able to move independently from the moment she awoke, which allowed for rapid recovery and discharge. IV dexamethasone might have contributed to a prolonged block, as seen in other regional techniques.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Other authors typically mention a volume of 20–30<span class="elsevierStyleHsp" style=""></span>ml per side while performing this block; nonetheless, we opted for a lower volume due to the need for less extensive dermatomal coverage, theoretical lower risk of hypotensive episodes, and satisfactory spread observed during injection.</p><p id="par0065" class="elsevierStylePara elsevierViewall">While short-acting opioids are a highly popular hypotensive strategy in this type of procedure, they are not required when the block is performed preoperatively, other than fentanyl for orotracheal intubation. This might be due to spread of the local anaesthetic to the paravertebral and epidural spaces, which blocks the thoracolumbar outflow of the sympathetic nervous system.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The resulting vasodilation and hypotension are invaluable in spine surgery as they reduce intra and postoperative haemorrhage, and this, in our opinion, is another advantage of the ESPB. Thus, we believe the ESPB may play an important role in reducing remifentanil-induced hyperalgesia (a problem which, to our knowledge, only <span class="elsevierStyleItalic">N</span>-methyl-<span class="elsevierStyleSmallCaps">d</span>-aspartate receptor antagonists, such as ketamine and magnesium sulphate, can ameliorate). It may also prevent chronic postoperative pain and enable opioid-free anaesthesia strategies.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">We emphasise the need for studies in the application of ESPB in spine surgery and its possible complications. Anaesthesiologists must be alert for accidental dura mater tear during the surgical procedure. This can allow a considerable amount of local anaesthetic to infiltrate the subarachnoid space, and could result in high, or even total, spinal block. Vigilance and effective communication between the anaesthetic and surgical teams is essential to avoid this, or to promptly identify and resolve such an event should it occur. Performing the block postoperatively would lower this risk, but may also compromise many of its intraoperative advantages.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In summary, the ESPB has numerous applications, and is a simple, safe analgesic approach in lumbar spine surgery, with multiple advantages that extend well beyond its analgesic efficacy.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no funding to declare.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1160521" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1086817" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1160522" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1086816" "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" => "Funding" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack396243" "titulo" => "Acknowledgement" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-30" "fechaAceptado" => "2018-10-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1086817" "palabras" => array:4 [ 0 => "Lumbar spine surgery" 1 => "Erector spinae plane block" 2 => "Multimodal analgesia" 3 => "Regional anaesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1086816" "palabras" => array:4 [ 0 => "Cirugía de la columna lumbar" 1 => "Bloqueo del plano del erector de la columna" 2 => "Analgesia multimodal" 3 => "Anestesia regional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report the successful clinical case of a patient scheduled for lumbar spine surgery in which we performed a bilateral single-shot erector spinae plane block as part of a multimodal analgesic strategy for pain control. Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation, and enabled the use of paracetamol for analgesia only. Further, there was no need for hypotensive techniques, as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field. Postoperatively, the patient had minor opioid consumption and was able to freely move without any motor impairment or pain from early on in the Post Anaesthesia Care Unit. The use of single-shot erector spinae plane block at the lumbar level for lumbar spine surgery analgesia emphasises its wide application and analgesic efficacy.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Divulgamos el caso clínico de una paciente programada para cirugía de la columna lumbar, en la cual realizamos el bloqueo del plano del músculo erector de la columna lumbar como parte de una estrategia analgésica multimodal para el control del dolor agudo. La realización del bloqueo preoperatoriamente descartó la necesidad de opioides intraoperatorios adicionales a los de la intubación y permitió el uso de paracetamol solo para la analgesia. Además, no hubo necesidad de técnicas hipotensivas, ya que el bloqueo proporcionó bloqueo simpático satisfactorio y vasodilatación regional con un campo quirúrgico claro. En el postoperatorio, la paciente tenía un consumo menor de opiáceos y podía moverse libremente sin ningún deterioro motor, ni dolor desde el principio en la Unidad de Cuidados Postanestésicos. El uso del bloqueo del plano del músculo erector de la columna lumbar a nivel lumbar para la analgesia en la cirugía de la columna lumbar enfatiza su amplia aplicación y eficacia analgésica.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Brandão J, Graça R, Sá M, Cardoso JM, Caramelo S, Correia C. Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico. Rev Esp Anestesiol Reanim. 2019;66:167–171.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 850 "Tamanyo" => 104184 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demonstration of prone positioning for the ESPB at the lumbar level. (Note that aseptic precautions were taken before performing the block.)</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" => 1237 "Ancho" => 1133 "Tamanyo" => 185229 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ultrasound imaging of the transverse process at L4.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1160 "Ancho" => 1133 "Tamanyo" => 192454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ultrasound imaging of the ESPB after performing the block. Note the spread of local anaesthetic beneath the erector spinae muscle. TP – transverse process, N – needle, ESM – erector spinae muscle, LA – local anaesthetic.</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" => "Pain management following spinal surgeries: an appraisal of the available options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.J. Bajwa" 1 => "R. 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