Medicina Fluminensis, Vol. 62 No. 3, 2026.
Studija slučaja
https://doi.org/10.21860/medflum2026_349236
Opioid-Sparing Analgesia Using a Bilateral Erector Spinae Plane Block for Bilateral Mastectomy with Immediate Reconstruction: A Case Report
Danijel Knežević
; University of Rijeka, Faculty of Medicine, Rijeka, Croatia
Damir Juranić
; University Hospital Centre Rijeka, Department of Surgery, Rijeka, Croatia
Katarina Brezić
; General Hospital Pula, Department of Anaesthesiology, Intensive Medicine and Pain Therapy, Pula, Croatia
Abedin Asani
; General Hospital Pula, Department of Anaesthesiology, Intensive Medicine and Pain Therapy, Pula, Croatia
Janja Tarčuković
; University of Rijeka, Faculty of Medicine, Rijeka, Croatia
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* Dopisni autor.
Sažetak
Aim: Bilateral mastectomy with immediate reconstruction (DMX-DTI) presents a significant perioperative pain management challenge. While systemic opioids are traditionally used, their side effects, especially in patients with history of adverse reactions, have prompted increasing interest in regional anaesthesia techniques. This case report aims to present the use of bilateral erector spinae plane block (ESPB) as an opioid-sparing strategy for patients undergoing bilateral mastectomy. Case report: We describe a 39-year-old female who underwent DMX-DTI and requested an opioid-sparing anaesthetic techniques due to her history of postoperative nausea and vomiting (PONV) following epidural analgesia and anaesthesia. Bilateral ultrasound-guided ESPB catheters were placed preoperatively, and an initial bolus of 20 mL of 0.25% levobupivacaine per side was administered. General anaesthesia was induced with midazolam, propofol, ketamine, dexmedetomidine, and a single opioid dose at induction, with no intraoperative opioid boluses. Postoperatively, ESPB boluses consisted of 0.25% levobupivacaine, combined with dexmedetomidine (1 μg/mL) to prolong block duration. The patient reported low pain scores postoperatively, with VAS remaining ≤3 throughout hospitalization and no need for systemic opioids. Conclusion: This case underscores the usefulness of ESPB as a safe and effective opioid-sparing technique for major breast surgery. Given the consistent analgesia, ease of catheter placement, and a favourable patient outcome, further studies should investigate ESPB’s role in enhanced recovery protocols for breast surgery.
Ključne riječi
analgesics, non-narcotic; anaesthesia, conduction; mastectomy; pain management
Hrčak ID:
349236
URI
Datum izdavanja:
1.9.2026.
Posjeta: 0 *