Pain relief and safety of the Erector Spinae Block in patients undergoing chest surgery

Performing an erector spinae block in patients undergoing video-assisted thorascopic surgery at the Royal Brisbane and Women's Hospital and The Prince Charles Hospital: After informed consent, placement of the ESB will proceed in the sitting position in a similar fashion to a paravertebral or neuraxial block by the treating anaesthetist with appropriate training or specialist regional anaesthesia anaesthetist. The posterior hemithorax on the correct surgical side will be identified and the skin prepared with 2% chlorhexidine in 70% alcohol. In a sterile fashion, using a 10-15MHz US-probe an anaesthetist proficient in the technique will identify the transverse process of the 5th-7th thoracic vertebrae. Muscles layers of trapezius, rhomboid major and erector spinae will be visualized and utilizing an in-plane technique a 16/18G Touhey needle will be inserted until it comes in contact with the transverse process which it the most posterior border of the fascial plane below the erector spinae muscle. An initial bolus dose of 20mL of 0.375% ropivicaine will be injected and the spread of local anaesthetic within the plane confirmed with US. Through the needle a multi-orifice catheter will be inserted and placed in the fascial plane to a depth of 3cm. It’s position will be confirmed by injecting 5mL of 0.375% ropivicaine down the catheter under US-guidance. Catheter will be secured in an appropriate technique by the anaesthetist placing the block. On average it is expected to take between 15-30 minutes to perform this block. Patients will then proceed to the operating theatre to have their VATS procedure. At the end of their operation a further 10mL of 0.375% ropivicaine will be given down the catheter prior to their arrival in PACU. It is anticipated that the catheter will remain in-situ for 2/7 with an hourly 10mL bolus of 0.2% ropivicaine.