RESUMO
La anestesia multimodal, combinando catéter epidural y anestesia general, es una técnica habitual en cirugía torácica, sin embargo, la colocación del catéter epidural no siempre es posible. Recientemente se ha descrito el bloqueo del plano del músculo erector de la columna, que proporciona analgesia similar a la del bloqueo epidural, aunque unilateral, y que se ha utilizado en diversos procedimientos a nivel torácico. En la actualidad no hay estudios que comparen la eficacia o la seguridad de este bloqueo con los habitualmente empleados en cirugía torácica. Sin embargo, su perfil de seguridad y contraindicaciones parecen diferentes a las del catéter epidural, ya que su colocación es ecodirigida, la introducción de la aguja se realiza mediante control en plano y la diana ecográfica, la apófisis transversa, es fácilmente identificable y está relativamente alejada de estructuras neurales o vasculares mayores y de la pleura. A diferencia de otros bloqueos realizados por referencias anatómicas, el bloqueo del plano del erector de la columna puede realizarse con diferentes posiciones del paciente. Describimos nuestra experiencia con el bloqueo del plano del músculo erector de la columna como parte de un abordaje anestésico multimodal en cirugía torácica
Multimodal anaesthesia, combining epidural catheter and general anaesthesia, is a common technique in thoracic surgery, however, epidural catheter placement is not always possible. Recently, erector spinae plane block has been described, which provides analgesia like that of the epidural block, although unilateral, and which has been used in various procedures at thoracic level. At present, there are no studies comparing the efficacy or safety of this block with those commonly used in thoracic surgery. However, its safety profile and contraindications seem different from those of the epidural catheter, since its placement is done under ultrasound view, the needle introduction is done in plane and the ultrasound target, the transverse process, is easily identifiable and is relatively remote from major neural or vascular structures and the pleura. Unlike other blockages made by anatomical references, erector spinae plane block can be done with the patient in different positions. We describe our experience with erector spinae plane block as part of a multimodal anaesthetic approach in thoracic surgery
Assuntos
Humanos , Bloqueio Neuromuscular/métodos , Cirurgia Torácica Vídeoassistida/métodos , Anestesia/métodos , Coluna Vertebral/inervação , Terapia Combinada , Dor Pós-Operatória/tratamento farmacológico , Analgesia/métodosRESUMO
Multimodal anaesthesia, combining epidural catheter and general anaesthesia, is a common technique in thoracic surgery, however, epidural catheter placement is not always possible. Recently, erector spinae plane block has been described, which provides analgesia like that of the epidural block, although unilateral, and which has been used in various procedures at thoracic level. At present, there are no studies comparing the efficacy or safety of this block with those commonly used in thoracic surgery. However, its safety profile and contraindications seem different from those of the epidural catheter, since its placement is done under ultrasound view, the needle introduction is done in plane and the ultrasound target, the transverse process, is easily identifiable and is relatively remote from major neural or vascular structures and the pleura. Unlike other blockages made by anatomical references, erector spinae plane block can be done with the patient in different positions. We describe our experience with erector spinae plane block as part of a multimodal anaesthetic approach in thoracic surgery.
