New indication for novel block: sacral erector spinae plane block for inferior cluneal/sacral nerve entrapment syndrome
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CitationTulgar, S., Selvi, O., Thomas, D.T. ve Özer, Z. (2019). New indication for novel block: sacral erector spinae plane block for inferior cluneal/sacral nerve entrapment syndrome. Regional Anesthesia & Pain Medicine. 44, s. 230.
Background and aims: Inferior cluneal nerve entrapment syndrome (ICNES) is a rare and painful condition. Piriformis injections, piriformis release and caudal injections are used in the treatment. Herein, we report our successful application of sacral erector spinae plane block (ESPB) in a patient suffering from persistent ICNES. Methods: A 72-year-old female patient, who had been taking oral tramadol, gabapentin and paracetamol due to the pain in her left inferomedial gluteal region for 4 years, was scheduled for sacral ESPB. Formerly, the patient received piriformis injection twice, caudal injection twice in addition to a pudendal nerve block, and a pudendal nerve release surgery. High frequency linear transducer was placed on the fifth spinous process on the transverse plane when the patient was in the prone position. The transducer was then placed 3-4 cm lateral to the second medial sacral crest to visualise the intermediate sacral crest. In the interfascial plane, 20 mL of local anesthetic (10 mL bupivacaine 0.5%, 5 mL lidocaine 2%, 40 mg/2 mL metilprednizolon ve 3 mL normal saline) was injected between the erector spinae muscles and intermediate sacral crest. Results: The patient expressed relief of her pain after 5 minutes following sacral ESPB application. At the third week of post-intervention period, she no longer required oral medication. The intervention was repeated after 6 weeks due to mild pain. Conclusions: Sacral ESPB may be a good option in cases with entrapment syndrome of posterior sacral nerve branches.
SourceRegional Anesthesia & Pain Medicine
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