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... his CT/chest X-ray showed pleural apical thickening, reflecting progressive radiation fibrosis, superimposed infection/inflammation and recurrent malignancy [Chest X-ray Figure 2]. ...

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... In this case, continuous infusion of 0.2% ropivacaine 4-6 ml/h was used. [10] Our case report suggests that the continuous ESP block using intermittent boluses can be successfully used for postoperative analgesia as a part of multimodal analgesia regimen even in procedures such as OC, which are associated with highintensity postoperative pain. ...
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The ultrasound-guided erector spinae plane (ESP) block has been recently described for postoperative analgesia after various thoracic and abdominal surgeries, mostly laparoscopic. Some authors suggest that the ESP block has an effect on both visceral and somatic pain. We describe the successful use of continuous ESP block using intermittent boluses via catheter in open cholecystectomy (OC). Our patient was scheduled for laparoscopic cholecystectomy, which unexpectedly led to open procedure. Continuous ESP block provided good analgesia for 96 h after surgery. To our knowledge, this is the first case report of the use of continuous ESP block using intermittent boluses for OC.
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PurposeAfter laparoscopic cholecystectomy patients have moderate pain in the early postoperative period. According to several studies an erector spinae plane (ESP) block can be a valuable part of multimodal analgesia. Our intention was to evaluate how ESP block influences postoperative pain scores and opioid consumption after laparoscopic cholecystectomy.Methods This single-blinded, prospective, randomized study included 60 patients undergoing laparoscopic cholecystectomy to receive either bilateral ESP block at the Th 7 level (n = 30) with 20 ml of 0.25% levobupivacaine plus dexamethasone 2 mg per side, or standard multimodal analgesia (n = 30). Patients from the standard multimodal analgesia group received tramadol 100 mg at the end of the procedure. Postoperative analgesia for both groups was acetaminophen 1 g/8 h i.v. and ketorolac 30 mg/8 h. Tramadol 1 mg/kg was a rescue treatment for pain breakthrough (numeric rating scale/NRS ≥ 6) in both groups. Pain at rest was recorded at 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 24 h after surgery using NRS (0–10).ResultsAn ESP block significantly reduced postoperative pain scores compared to standard multimodal analgesia after 10 min (p = 0.011), 30 min (p = 0.004), 2 h (p = 0.011), 4 h (p = 0.003), 8 h (p = 0.013), 12 h (p = 0.004) and 24 h (p = 0.005). Tramadol consumption was significantly lower in the ESP group 25.02 ± 56.8g than in the standard analgesia group 208.3 ± 88.1g (p < 0.001).Conclusion An ESP block can provide superior postoperative analgesia and reduction in opioid requirement after laparoscopic cholecystectomy
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Six dogs were presented to the University College Dublin Veterinary Hospital for either left or right lateral thoracotomy. After opioid premedication and induction of general anaesthesia, ultrasound‐guided erector spinae plane (ESP) block with bupivacaine 0.5% (0.5 mL/kg) or bupivacaine 0.25% (1 mL/kg) was performed in all cases before the surgical procedure along with morphine (0.2 mg/kg) administered epidurally. This combination of local techniques was a successful adjunct to systemic analgesia in these six dogs undergoing lateral thoracotomy, reducing considerably the need for systemic opioids intra‐ and post‐operatively. Ultrasound‐guided ESP block with bupivacaine and epidurally administered morphine provided good multimodal intra‐operative analgesia for dogs undergoing lateral thoracotomy.
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Patients with sepsis in the intensive care unit present a challenge when it comes to pain control, as the balance between pain control and maintenance of their vital signs is paramount. Improving their pain risks losing the sympathetic tone that maintains their vitals including blood pressure, pulse, and perfusion. Therefore, priority is directed towards maintaining vital tissue perfusion and the usage of short/ultrashort acting analgesics is preferred with close attention to any change in vital signs. This can be accomplished through the use of multimodal analgesia and interventional pain techniques. The risks and benefits of various medications and interventions are discussed and an overall management strategy is outlined.