Erector plane blockade for opioid-free C-section delivery: case report
DOI:
https://doi.org/10.37497/JMRReview.v4i00.79Keywords:
ESP block, Anesthesiology, Obstetrics, Opioid Free Anesthesia, Hypersensitivity, C-section deliveryAbstract
Background: Regional anesthesia, widely used in caesarean sections due to its efficacy and safety, often includes opioids to enhance analgesia. However, its use is limited in allergic patients, requiring alternatives such as non-opioid adjuvants or specific techniques. The erector spinae muscle plane block (ESP block) has emerged as a safe and effective approach in these cases, providing multi-level analgesia with a low risk of complications. It is indicated in various surgical contexts and in pain management, standing out for its technical simplicity and clinical relevance in multimodal pain control.
Aim: To report on the use of the ESP block for an opioid-free C-section delivery. Methodology: We present the case of a parturient woman seen at the Hospital Universitário São Francisco na Providência de Deus (HUSF), located in the city of Bragança Paulista - SP, Brazil, with due authorization through the signing of a Free and Informed Consent Form. Case Report: C.P.S., 36 years old, multiparous at 40 weeks and 1 day of gestation, was admitted due to a change in blood pressure, and a caesarean section was indicated. The patient had untreated gestational hypertension and a history of anaphylactic reaction during a previous C-section delivery. A subarachnoid block was performed without opioids and the antibiotic was replaced with clindamycin. During the post-operative period, the pain was controlled with analgesics and the patient progressed without complications. The patient was discharged from hospital after 48 hours, with no complaints and prescribed routine medication. The patient had a favorable clinical evolution, with an adequate response to anesthetic and postoperative management, and was discharged in good condition.
Conclusion: The case highlights the importance of individualized management, taking into account the patient's clinical history and adverse reactions. The opioid-free anesthetic approach, combined with antibiotic replacement and the use of ultrasound-guided regional blockade, proved to be effective and safe. The patient had a favorable postoperative evolution, with adequate pain control and discharge from hospital in good condition, demonstrating the success of the planning and execution of the multi-professional team.
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