Erector spinae block for postoperative analgesia following axillary hi

Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen

Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA

Abstract: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions. Lesions can be severely painful on their own or following surgical resection. Patients may require opioid therapy due to pain from the lesions themselves or following painful surgical resection. Erector spinae block (ESB) is a recently developed plane block used for the management of pain located in the chest wall or the abdominal wall. Ultrasound guidance is used to guide placement of the needle tip between the transverse process at the desired dermatomal level and the erector spinae muscle group. Traditional descriptions of the ESB have been at the level of the fifth transverse process to treat chest wall pain; in this case report, we describe a novel use of ESB at the level of the second transverse process to treat axillary pain after surgical debridement of axillary HS.

Keywords: erector spinae block, hidradenitis suppurativa, axillary pain, truncal blocks, ultrasound-guided blocks, axillary analgesia, thoracic analgesia, thoracic wall block, peripheral nerve block

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