metricas
covid
Buscar en
Revista Española de Anestesiología y Reanimación (English Edition)
Toda la web
Inicio Revista Española de Anestesiología y Reanimación (English Edition) Lumbar erector spinae plane block: Successful control of acute pain after lumbar...
Journal Information

Statistics

Follow this link to access the full text of the article

Case report
Lumbar erector spinae plane block: Successful control of acute pain after lumbar spine surgery – A clinical report
Bloqueo lumbar del plano del músculo erector de la columna: control exitoso del dolor agudo tras cirugía de la columna lumbar. Un caso clínico
J. Brandão
Corresponding author
jocbrandao@gmail.com

Corresponding author.
, R. Graça, M. Sá, J.M. Cardoso, S. Caramelo, C. Correia
Departamento de Anestesiología y Terapia del Dolor, Centro Hospitalar de Trás-Os-Montes e Alto Douro, EPE, Vila Real, Portugal
Read
4
Times
was read the article
0
Total PDF
4
Total HTML
Share statistics
 array:24 [
  "pii" => "S2341192919300320"
  "issn" => "23411929"
  "doi" => "10.1016/j.redare.2018.10.005"
  "estado" => "S300"
  "fechaPublicacion" => "2019-03-01"
  "aid" => "978"
  "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor"
  "copyrightAnyo" => "2018"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2019;66:167-71"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2
    "HTML" => 2
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0034935618301920"
      "issn" => "00349356"
      "doi" => "10.1016/j.redar.2018.10.005"
      "estado" => "S300"
      "fechaPublicacion" => "2019-03-01"
      "aid" => "978"
      "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Rev Esp Anestesiol Reanim. 2019;66:167-71"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 295
        "formatos" => array:2 [
          "HTML" => 186
          "PDF" => 109
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Caso cl&#237;nico</span>"
        "titulo" => "Bloqueo lumbar del plano del m&#250;sculo erector de la columna&#58; control exitoso del dolor agudo tras cirug&#237;a de la columna lumbar&#46; Un caso cl&#237;nico"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "167"
            "paginaFinal" => "171"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Lumbar erector spinae plane block&#58; Successful control of acute pain after lumbar spine surgery - A clinical 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" => 1237
                "Ancho" => 1133
                "Tamanyo" => 184972
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes ecogr&#225;ficas del proceso transverso al nivel de L4&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; Brand&#227;o, R&#46; Gra&#231;a, M&#46; S&#225;, J&#46;M&#46; Cardoso, S&#46; Caramelo, C&#46; Correia"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Brand&#227;o"
              ]
              1 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Gra&#231;a"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "S&#225;"
              ]
              3 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Cardoso"
              ]
              4 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Caramelo"
              ]
              5 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Correia"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341192919300320"
          "doi" => "10.1016/j.redare.2018.10.005"
          "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/S2341192919300320?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935618301920?idApp=UINPBA00004N"
      "url" => "/00349356/0000006600000003/v1_201902210632/S0034935618301920/v1_201902210632/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341192919300307"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2018.12.001"
    "estado" => "S300"
    "fechaPublicacion" => "2019-03-01"
    "aid" => "988"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2019;66:172-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Intervention to reduce pain in patients with superficial and intermediate second degree burns"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "172"
          "paginaFinal" => "173"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "A prop&#243;sito de una intervenci&#243;n para disminuir el dolor a pacientes con quemaduras de segundo grado intermedio-superficiales"
        ]
      ]
      "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" => 864
              "Ancho" => 905
              "Tamanyo" => 80243
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Enzymatic debridement with Nexobrid<span class="elsevierStyleSup">&#174;</span> in a patient with infraclavicular catheter &#40;arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; Luengo-Pastor, R&#46; Guerrero-Dom&#237;nguez, E&#46;C&#46; Navarro-Su&#225;rez, C&#46; Rasero-Moreno"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Luengo-Pastor"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Guerrero-Dom&#237;nguez"
            ]
            2 => array:2 [
              "nombre" => "E&#46;C&#46;"
              "apellidos" => "Navarro-Su&#225;rez"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "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 Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 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&#39;s syndrome&#58; 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" => "Tiroidectom&#237;a total en paciente con s&#237;ndrome de McArdle&#58; manejo anest&#233;sico"
        ]
      ]
      "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&#46;V&#46; Quintero Salvago, J&#46;D&#46; Leal del Ojo del Ojo, L&#46; Barrios Rodr&#237;guez, J&#46;J&#46; Fedriani de Matos, I&#46; Morgado Mu&#241;oz"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "A&#46;V&#46;"
              "apellidos" => "Quintero Salvago"
            ]
            1 => array:2 [
              "nombre" => "J&#46;D&#46;"
              "apellidos" => "Leal del Ojo del Ojo"
            ]
            2 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Barrios Rodr&#237;guez"
            ]
            3 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Fedriani de Matos"
            ]
            4 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Morgado Mu&#241;oz"
            ]
          ]
        ]
      ]
    ]
    "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&#58; Successful control of acute pain after lumbar spine surgery &#8211; A clinical report"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "167"
        "paginaFinal" => "171"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; Brand&#227;o, R&#46; Gra&#231;a, M&#46; S&#225;, J&#46;M&#46; Cardoso, S&#46; Caramelo, C&#46; Correia"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "Brand&#227;o"
            "email" => array:1 [
              0 => "jocbrandao&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "R&#46;"
            "apellidos" => "Gra&#231;a"
          ]
          2 => array:2 [
            "nombre" => "M&#46;"
            "apellidos" => "S&#225;"
          ]
          3 => array:2 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Cardoso"
          ]
          4 => array:2 [
            "nombre" => "S&#46;"
            "apellidos" => "Caramelo"
          ]
          5 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Correia"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Departamento de Anestesiolog&#237;a y Terapia del Dolor&#44; Centro Hospitalar de Tr&#225;s-Os-Montes e Alto Douro&#44; EPE&#44; Vila Real&#44; Portugal"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Bloqueo lumbar del plano del m&#250;sculo erector de la columna&#58; control exitoso del dolor agudo tras cirug&#237;a de la columna lumbar&#46; Un caso cl&#237;nico"
      ]
    ]
    "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&#46; Note the spread of local anaesthetic beneath the erector spinae muscle&#46; TP &#8211; transverse process&#44; N &#8211; needle&#44; ESM &#8211; erector spinae muscle&#44; LA &#8211; local anaesthetic&#46;</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&#46; Adequate pain management facilitates improved functional outcome&#44; early ambulation and discharge&#44; and prevents the development of chronic pain&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Possible analgesic regimens include conventional intravenous pain therapy&#44; ketamine or local anaesthetic infusions&#44; and neuroaxial blocks&#46; Regional techniques have numerous recognised benefits in spine surgery&#44; including a cleaner surgical field &#40;provided by hypotension and vasodilation due to sympathetic blockade&#41;&#44; a more stable intraoperative haemodynamic profile&#44; reduced blood loss and thromboembolic complications&#44; opioid-sparing effects&#44; and prolonged postoperative analgesia&#46;<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&#46; The ultrasound-guided erector spinae plane block &#40;ESPB&#41; at the T5 transverse process is a technique recently described by Forero et al&#46; for thoracic analgesia&#46; Local anaesthetic injected into the fascial plane deep to the erector spinae muscle spreads in a cranio-caudal fashion over several levels&#44; allowing for multidermatomal coverage&#46; It also penetrates anteromedially through the intertransverse connective tissue and enters the epidural and thoracic paravertebral space&#44; where it can potentially block not only the ventral and dorsal rami of the spinal nerves&#44; but also the <span class="elsevierStyleItalic">rami communicantes</span> that transmit sympathetic information&#46;<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&#44; including its use in acute pain relief after abdominal<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> and thoracic surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a> Additionally&#44; there is a recent description of ESPB at the lumbar level providing good postoperative analgesia for total hip arthroplasty&#46;<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&#44; we hypothesised that ESPB at the lumbar level could be useful for several reasons&#59; namely&#44; intraoperative haemodynamic stability&#44; blood loss and analgesia&#44; and also in the control of acute postoperative pain and chronic pain development after spine surgery&#46;</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 &#40;L4&#8211;L5&#41; fusion&#44; due to spondylolisthesis&#46; The patient&#39;s medical history included dyslipidaemia&#44; well controlled hypertension&#44; asthma&#44; and overweight &#40;weight 66<span class="elsevierStyleHsp" style=""></span>kg&#44; height 1&#46;58<span class="elsevierStyleHsp" style=""></span>m&#44; body mass index 26&#46;50<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#46; She complained of chronic &#40;&#62;3 months&#41; lumbar pain&#44; which did not respond to paracetamol&#44; NSAIDs&#44; and physical therapy&#46; The patient agreed to undergo surgical treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A brief preoperative neurological examination was performed&#44; which showed no motor impairment of lower limbs or sensory deficits&#46; She did not present hyperalgesia or allodynia&#46; Pain was restricted to the lumbar area with no pain irradiation&#44; and worsened with movement&#44; and improved with rest&#46; Moreover&#44; palpation revealed some painful muscular contractures of the paravertebral muscles&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Before general anaesthesia induction&#44; we performed a modified ultrasound guided erector spinae block at the lumbar level L4&#46; With the patient in a sitting position&#44; 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 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; At this level&#44; the only muscle identified superficial to the hyperechoic transverse process is the erector spinae muscle &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A 50<span class="elsevierStyleHsp" style=""></span>mm 22<span class="elsevierStyleHsp" style=""></span>G ultrasound needle &#40;PAJUNK<span class="elsevierStyleSup">&#174;</span>&#41; was inserted in-plane in a cephalad to caudal direction until bone contact with the top of the transverse process&#46; After slight retraction of the needle&#44; 15<span class="elsevierStyleHsp" style=""></span>ml of 0&#46;375&#37; ropivacaine was injected deep to the erector spinae muscle&#44; and cephalad to caudal spread of the local anaesthetic was promptly observed &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The same procedure was repeated on the contralateral side&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">General anaesthesia was induced intravenously &#40;IV&#41; with 200<span class="elsevierStyleHsp" style=""></span>&#956;g of fentanyl&#44; 120<span class="elsevierStyleHsp" style=""></span>mg of propofol&#44; and 40<span class="elsevierStyleHsp" style=""></span>mg of rocuronium&#46; Additionally&#44; 4<span class="elsevierStyleHsp" style=""></span>mg of IV dexamethasone were administered immediately after induction&#46; The patient was intubated and placed in the prone position&#46; Monitoring was performed according to American Society of Anaesthesiology standards&#44; Bispectral Index &#40;BIS<span class="elsevierStyleSup">&#174;</span>&#41;&#44; and quantitative neuromuscular blockade&#46; Sevoflurane was the chosen inhaled agent for anaesthesia maintenance&#44; with a 35&#37; FiO<span class="elsevierStyleInf">2</span>&#58;Air&#46; The patient remained haemodynamically stable throughout the procedure&#46; Mean arterial pressures were maintained at around 65<span class="elsevierStyleHsp" style=""></span>mmHg and heart rate around 60 beats per minute&#44; with no need for vasopressors&#44; hypotensive agents or additional opioids&#46; BIS was used to guide anaesthesia depth and was maintained at around 40 with a stable and reduced MAC &#40;maximum MAC 0&#46;8&#41;&#46; The patient was only given 1<span class="elsevierStyleHsp" style=""></span>g IV paracetamol intraoperatively for analgesia&#46; The procedure lasted for approximately 3<span class="elsevierStyleHsp" style=""></span>h in the prone position&#44; 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&#46; The patient awoke absolutely pain-free and without nausea&#46;</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&#46; At that time&#44; she was able to autonomously move to her bed with no pain or motor impairment&#46;</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&#46; On the back&#44; the sensory block extended bilaterally from T10 to S2&#46; On the front&#44; it extended up to T8 on the left and T10 on the right from S2&#46; This evaluation was performed every 12<span class="elsevierStyleHsp" style=""></span>h after surgery&#44; and remained unchanged until 48<span class="elsevierStyleHsp" style=""></span>h after surgery&#44; when the block finally receded&#46; During this time&#44; 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&#46; The pump had no baseline perfusion&#44; but allowed a bolus of 1<span class="elsevierStyleHsp" style=""></span>mg of morphine every 7<span class="elsevierStyleHsp" style=""></span>min&#46; In the first two days after surgery&#44; she required 6<span class="elsevierStyleHsp" style=""></span>mg of morphine per day&#46; The postoperative period was uneventful&#46; She remained pain-free at rest&#44; and the maximum reported pain score with movement was mild &#40;numeric rating score 3&#8211;4 out of 10&#41;&#46; On the third day&#44; the pump was removed and the patient was discharged&#46; The patient was extremely satisfied with the analgesic strategy&#46;</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&#44; three muscles are identified superficial to the hyperechoic transverse process shadow&#58; trapezius&#44; rhomboid major&#44; and erector spinae&#46; The trapezius muscle originates in the superior nuchal line&#44; inion&#44; nuchal ligament and spinous processes of C7&#8211;T12&#44; and inserts onto the clavicle and scapula&#44; whereas the rhomboid major muscle arises from the spinous processes of T2&#8211;5 and inserts onto the scapula&#46; 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&#46; broad tendon on the back of the sacrum&#44; the inner side of the iliac crest&#44; sacroiliac ligaments&#44; and lumbosacral spinous processes&#46; Given this&#44; only the erector spinae muscle can be identified at the lumbar level superficial to the transverse processes&#44; covered by the thoracolumbar fascia&#46; The erector spinae&#39;s relationship with the paravertebral space and neighbouring structures does not change from the thoracic to lumbar region&#44; justifying the block&#39;s feasibility at the lumbar level&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The ESPB is an effective&#44; simple and safe analgesic technique with numerous applications&#44; particularly when compared to paravertebral block and epidural analgesia techniques&#44; with their well-known risks and side effects&#46; The patient was pain-free and able to move independently from the moment she awoke&#44; which allowed for rapid recovery and discharge&#46; IV dexamethasone might have contributed to a prolonged block&#44; as seen in other regional techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Other authors typically mention a volume of 20&#8211;30<span class="elsevierStyleHsp" style=""></span>ml per side while performing this block&#59; nonetheless&#44; we opted for a lower volume due to the need for less extensive dermatomal coverage&#44; theoretical lower risk of hypotensive episodes&#44; and satisfactory spread observed during injection&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">While short-acting opioids are a highly popular hypotensive strategy in this type of procedure&#44; they are not required when the block is performed preoperatively&#44; other than fentanyl for orotracheal intubation&#46; This might be due to spread of the local anaesthetic to the paravertebral and epidural spaces&#44; which blocks the thoracolumbar outflow of the sympathetic nervous system&#46;<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&#44; and this&#44; in our opinion&#44; is another advantage of the ESPB&#46; Thus&#44; we believe the ESPB may play an important role in reducing remifentanil-induced hyperalgesia &#40;a problem which&#44; to our knowledge&#44; only <span class="elsevierStyleItalic">N</span>-methyl-<span class="elsevierStyleSmallCaps">d</span>-aspartate receptor antagonists&#44; such as ketamine and magnesium sulphate&#44; can ameliorate&#41;&#46; It may also prevent chronic postoperative pain and enable opioid-free anaesthesia strategies&#46;<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&#46; Anaesthesiologists must be alert for accidental dura mater tear during the surgical procedure&#46; This can allow a considerable amount of local anaesthetic to infiltrate the subarachnoid space&#44; and could result in high&#44; or even total&#44; spinal block&#46; Vigilance and effective communication between the anaesthetic and surgical teams is essential to avoid this&#44; or to promptly identify and resolve such an event should it occur&#46; Performing the block postoperatively would lower this risk&#44; but may also compromise many of its intraoperative advantages&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In summary&#44; the ESPB has numerous applications&#44; and is a simple&#44; safe analgesic approach in lumbar spine surgery&#44; with multiple advantages that extend well beyond its analgesic efficacy&#46;</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&#46;</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&#46;</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 => "Cirug&#237;a 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&#46; Performing the block preoperatively dismissed the need for extra intraoperative opioids other than those for intubation&#44; and enabled the use of paracetamol for analgesia only&#46; Further&#44; there was no need for hypotensive techniques&#44; as the block provided satisfactory sympathetic blockade and regional vasodilation with a clear surgical field&#46; Postoperatively&#44; 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&#46; 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&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Divulgamos el caso cl&#237;nico de una paciente programada para cirug&#237;a de la columna lumbar&#44; en la cual realizamos el bloqueo del plano del m&#250;sculo erector de la columna lumbar como parte de una estrategia analg&#233;sica multimodal para el control del dolor agudo&#46; La realizaci&#243;n del bloqueo preoperatoriamente descart&#243; la necesidad de opioides intraoperatorios adicionales a los de la intubaci&#243;n y permiti&#243; el uso de paracetamol solo para la analgesia&#46; Adem&#225;s&#44; no hubo necesidad de t&#233;cnicas hipotensivas&#44; ya que el bloqueo proporcion&#243; bloqueo simp&#225;tico satisfactorio y vasodilataci&#243;n regional con un campo quir&#250;rgico claro&#46; En el postoperatorio&#44; la paciente ten&#237;a un consumo menor de opi&#225;ceos y pod&#237;a moverse libremente sin ning&#250;n deterioro motor&#44; ni dolor desde el principio en la Unidad de Cuidados Postanest&#233;sicos&#46; El uso del bloqueo del plano del m&#250;sculo erector de la columna lumbar a nivel lumbar para la analgesia en la cirug&#237;a de la columna lumbar enfatiza su amplia aplicaci&#243;n y eficacia analg&#233;sica&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Brand&#227;o J&#44; Gra&#231;a R&#44; S&#225; M&#44; Cardoso JM&#44; Caramelo S&#44; Correia C&#46; Bloqueo lumbar del plano del m&#250;sculo erector de la columna&#58; control exitoso del dolor agudo tras cirug&#237;a de la columna lumbar&#46; Un caso cl&#237;nico&#46; Rev Esp Anestesiol Reanim&#46; 2019&#59;66&#58;167&#8211;171&#46;</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&#46; &#40;Note that aseptic precautions were taken before performing the block&#46;&#41;</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&#46;</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&#46; Note the spread of local anaesthetic beneath the erector spinae muscle&#46; TP &#8211; transverse process&#44; N &#8211; needle&#44; ESM &#8211; erector spinae muscle&#44; LA &#8211; local anaesthetic&#46;</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&#58; an appraisal of the available options"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;J&#46; Bajwa"
                            1 => "R&#46; Haldar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-8237.161589"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Craniovertebr Junction Spine"
                        "fecha" => "2015"
                        "volumen" => "6"
                        "paginaInicial" => "105"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26288544"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regional anaesthesia and postoperative analgesia techniques for spine surgery &#8211; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;M&#46; Benyahia"
                            1 => "A&#46; Verster"
                            2 => "V&#46; Saldien"
                            3 => "M&#46; Breebaart"
                            4 => "L&#46; Sermeus"
                            5 => "M&#46; Vercauteren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rom J Anaesth Intensive Care"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28913452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The erector spinae plane block&#58; a novel analgesic technique in thoracic neuropathic pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Forero"
                            1 => "S&#46;D&#46; Adhikary"
                            2 => "H&#46; Lopez"
                            3 => "C&#46; Tsui"
                            4 => "K&#46;J&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AAP.0000000000000451"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reg Anesth Pain Med"
                        "fecha" => "2016"
                        "volumen" => "41"
                        "paginaInicial" => "621"
                        "paginaFinal" => "627"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27501016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The analgesic efficacy of pre-operative bilateral erector spinae plane &#40;ESP&#41; blocks in patients having ventral hernia repair"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;J&#46; Chin"
                            1 => "S&#46; Adhikary"
                            2 => "N&#46; Sarwani"
                            3 => "M&#46; Forero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.13814"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2017"
                        "volumen" => "72"
                        "paginaInicial" => "452"
                        "paginaFinal" => "460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28188621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery&#58; a report of 3 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;J&#46; Chin"
                            1 => "L&#46; Malhas"
                            2 => "A&#46; Perlas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Reg Anesth Pain Med"
                        "fecha" => "2017"
                        "volumen" => "42"
                        "paginaInicial" => "372"
                        "paginaFinal" => "376"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The ultrasound-guided continuous erector spinae plane block for postoperative analgesia in video-assisted thoracoscopic lobectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Scimia"
                            1 => "E&#46; Basso Ricci"
                            2 => "A&#46; Droghetti"
                            3 => "P&#46; Fusco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AAP.0000000000000620"
                      "Revista" => array:5 [
                        "tituloSerie" => "Reg Anesth Pain Med"
                        "fecha" => "2017"
                        "volumen" => "42"
                        "paginaInicial" => "537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28632674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Erector spinae plane block provides effective pain management during pneumothorax surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Ueshima"
                            1 => "H&#46; Otake"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jclinane.2017.04.016"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2017"
                        "volumen" => "40"
                        "paginaInicial" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28625453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;letter&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound guided erector spinae plane block at L-4 transverse process level provides effective postoperative analgesia for total hip arthroplasty"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Tulgar"
                            1 => "O&#46; Senturk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jclinane.2017.11.006"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Anesth"
                        "fecha" => "2018"
                        "volumen" => "44"
                        "paginaInicial" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29149734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perineural versus intravenous dexamethasone as an adjuvant for peripheral nerve blocks&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Chong"
                            1 => "N&#46;M&#46; Berbenetz"
                            2 => "C&#46; Lin"
                            3 => "S&#46; Singh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/AAP.0000000000000571"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reg Anesth Pain Med"
                        "fecha" => "2017"
                        "volumen" => "42"
                        "paginaInicial" => "319"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28252523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Remifentanil tolerance and hyperalgesia&#58; short-term gain&#44; long-term pain&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;H&#46; Yu"
                            1 => "D&#46;H&#46; Tran"
                            2 => "S&#46;W&#46; Lam"
                            3 => "M&#46;G&#46; Irwin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/anae.13602"
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "2016"
                        "volumen" => "71"
                        "paginaInicial" => "1347"
                        "paginaFinal" => "1362"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27734470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack396243"
        "titulo" => "Acknowledgement"
        "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">The authors would like to thank all the authors involved in this clinical case for their participation&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23411929/0000006600000003/v1_201903070610/S2341192919300320/v1_201903070610/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "71024"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cases Report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006600000003/v1_201903070610/S2341192919300320/v1_201903070610/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192919300320?idApp=UINPBA00004N"
]
Article information
ISSN: 23411929
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2023 March 2 0 2
2019 October 1 0 1
2019 September 1 0 1

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos