难治性急性医学疼痛的管理可能是具有挑战性的,特别是如果严重和失代偿的全身病理禁用神经轴技术和深外周阻滞。在这个案例报告中,我们提出了一种连续超声引导下腰椎竖脊肌平面阻滞(ESPB)用于大腿蜂窝织炎的多模式镇痛。病人是一名80岁的男性,由于右下肢蜂窝织炎引起的感染性休克而进入重症监护室,与多器官功能障碍有关。为了解决大腿顽固性疼痛,在L3进行超声引导的腰椎ESPB,放置神经导管和30毫升0.5%罗哌卡因,随后每6小时注射30毫升0.375%罗哌卡因,并逐步断奶。患者维持控制的疼痛,无需抢救镇痛。连续超声引导的腰椎ESPB是难治性急性内科疼痛和全身病理患者大腿镇痛的有效且安全的替代方法,该方法禁止其他区域性技术。
The management of refractory acute medical pain can be challenging, especially if severe and decompensated systemic pathologies contraindicate neuraxial techniques and deep peripheral blocks. In this
case report, we propose a continuous ultrasound-guided lumbar erector spinae plane block (ESPB) for multimodal analgesia of thigh cellulitis. The patient was an 80-year-old male, admitted to the intensive care unit due to septic shock originating from cellulitis of the right lower limb, associated with multiorgan dysfunction. To address refractory pain in the thigh, an ultrasound-guided lumbar ESPB at L3 was performed, with the placement of a perineural catheter and administration of 30 mL of 0.5% ropivacaine, followed by 30 mL boluses of 0.375% ropivacaine every six hours with progressive weaning. The patient maintained controlled pain without the need for rescue analgesia. Continuous ultrasound-guided lumbar ESPB is an effective and safe alternative for thigh analgesia in patients with refractory acute medical pain and systemic pathologies that contraindicate other regional techniques.